Family Medicine Flashcards
2 day old M infant with hip instability found on Barlow maneuver, next step?
Hip US
If positive, then ortho consult
Screening with US for hip dysplasia in…
all girls born breech
optional: girls with positive family history, boys breech
contraindications for administering MMR/rubella vaccine
pregnant (vaccine can cross placenta) CD4+ count < 200 chemo transplant recipients congenital immundodeficiency
newborn with non-erythematous, non-pustule acne
acne neonatorum
don’t pop them
newborn with erythematous, pusutule acne
erythema toxicum neonatorum
thromboprophylaxis for 62 F x total hip replacement
10-35 days of LMW heparin (enoxaparin), fondapariunoux, or warfarin
NOT SQ heparin
when start to introduce solids into diet of infant
4-6 mo
otherwise extrusion reflex = push food out of mouth
hematologic abnLs MC in pt receiving testosterone replacement
erythrocytosis
check HCT before tx, Q3-6 mo x 1 year, then yearly
risk VTE with increased HCT
borderline personality disorder
female
splitting
cutting
treatment plan for plantar fasciitis
- stretching
- avoid flat shoes and walking barefoot
- heel shoe inserts
- NSAIDs
- steroid inj
severe preeclampsia –> started on magnesium –> less responsive, decreased central reflexes –> administer ___?
MgSO4 toxicity –> 1st give calcium gluconate
62 M never had VZV as a child or vaccine, should he receive the VZV vaccine?
yes, he would benefit
FDA approved x age 50+ regardless of previous VZV or not
do not give VZV vaccine to
pregnant and immunocompromised
findings of PMR (polymyalgia rheumatica)
> 50 yo bilateral proximal girdle joints morning stiffness lasts > 30 m elevated ESR sx relieved with low-dose PO steroids
9 yo boy with fatigue, tonsillar hypertrophy, mod OSA –> next best step tx?
kid: adenotonsillectomy
CPAP if surgery contraindicated
adult: CPAP
18 F no period for past 2 months, next step
BhCG
52 F postmenopausal on long-term (>3 mo) prednisone for severe RA –> how care for bone health?
start bisphosphonate
bone building exercises
milk/yogurt PO calcium (1200 mg daily)
stop smoking
bone health for > 50 M on prednisone
start bisphosphonate
1200 mg calcium daily
800 IU vit D daily
stop smoking
78 M with DM, HTN presents with HFrEF, which of meds (lisinopril, pioglitazone ,glipizide, saxagliptin) are contributing to his CHF?
piogliatzone can casue fluid retention
- complicates CHF
- contraindicated in pt w/ NYHC III or IV
6 mo M with low grade fever, vom, and diarrhea –> tx?
regular age appropriate diet = continued breastfeeding
if more dehydrated, PO rehydration THEN start bf
*simple sugars (juice, soda) make diarrhea worse due to increased osmotic load in gut
28 F hx HPV warts, wants HPV vaccine
no, only up to age 26
start M+F 11-2 yo
***if she were <26 yo and had warts and non-manog relationship these things do NOT exclude her from the vaccine, ONLY AGE
62 M cramping left calf, improves with rest, dec pedal pulses, shiny and hairless shins –> next step
ABIs
positive ABI ratio
ankle/arm
< 0.90 = PAD
pruritic LEs, no obvious rash –> dx and tx
xerosis
MC cause of pruritis in the absence of pustular lesions
hydration with topical emollients
62 M hx of lung cancer has sCa2 15.1 mg/dL with nL serum albumin, polyuria, weakness –> next bes step
- NS hydration (promote Ca2+ diuresis in urine)
- calcitonin (quick, dec Ca2+ in hours)
- bisphosphonate (dec bone Ca2+ reabs)
PTHrP from squamous
8 mo F with antecubital and popliteal fossae rash, bother has it and uses pimecrolimus, what tell parents?
do not use pimecrolimus until 2 yo
- topical emollients
- low low corticosteroid topical
25 M producit ve cough x 7 d, no fever, no SOB, nL lung exam, acute bronchitis –> tx
supportive
42 F dx with RA, infliximab…what test before starting?
TB skin (PPD) hepatitis B surface antigen
65 M memory loss, wax/wane alertness, AH and VH, falls, resting tremor, mod rigidity, nL labs and nL CT –> Dx
Lewy Body Dementia
dementia, fluctuation cognition, hallucinations, Parkinsonism
22 F sexually active, gradually worsening dysuria and UTI, no fever, no growth bacteria on UC, no improvement with nitrofurantoin –> likely
G/C
tx DTs
benzos
2 mo M, exclusively BF so needs…
vitamin D
400 IU/daily in 1st week of life
26 M withdrawn, stops bathing, hear voices, no dep or mania, x 2 mo –> dx
schizophreniform
1-6mo
mother with chronic hep B wants to breastfeed her baby, what do you tell her?
okay!
22 F lethargy, irr menses, abd pain, xerosis, parotid gland swelling, erosion on dental enamel, B/P –> tx
CBT counseling
SSRI - fluoxetine
23 M asthma, SABA 3x/wk –> tx
SABA prn
start low dose ICS
> 2/wk = mild persistent asthma
USPSTF recs on AAA screening
male
65-75
smoking history
one time abd US
42 F gnawing mid-epigastric pain x 3 weeks, improves with eating
duodenal ulcer
h. pylori
42 F sora areas on proximal nail folds over several fingers, dishwarsher –> tx
chronic paronychia
- avoid irritants
- topical med/high corticosterodis
21 F 26w GA frequent migraine HA, but AVOID ___ med
imitrex (triptans) = vasoCNX uterine and placental vessles
ergotamine = uterine contx and abortifacent
migraine meds contraindicated in pregnancy
triptans
ergotamines
22 M with meningococcal meningitis, ppx for roommate?
rifampin PO
cipro PO
or
IM ceftriaxone
66 F TSH 11.0, free T4 nL –> dx
subclinical hypothyroidism
- likely to progress to frank hypothy
- assoc with CVD and inc LDL
- tx if TSH > 10
37 obese M diagnose type 2 –> tx
lifestyle changes
start metformin
(warn about gi upset)
ottawa ankle rules
- malleolar zone pain
- unable to bear weight
- tenderness at base of 5th metatarsal or navicular
68 F PPI x GERD, SE?
dec Ca2+ absorption –> inc risk hip fx and osteoporosis
inc risk CAP
inc risk c. diff colitis
dec b12 absorption
49 F abnl periods, dark blood at os, BhCG neg, HGB nL –> next step
endometrial biopsy
***in real life, endometrial US/transvaginal US
12 M bilatereal heel pain x 3-4 m, soccer, worse in practice, b/l posterior heel pain during dorsiflexion of ankles –> dx
calcanealapophysitis (Sever disease)
- inflammation due to rapid expansion of growth plate and oversue in sports
tx calcanealapophysitis
rest
RICE
NSAIds
22 F G1PO 38wGA, routine, fundus 40 cm, efw 4200g –> next best step
await spontaneous labor
C/S, no trial labor if:
- 4500 g + GDM/DM
- 5000 g + no diabetes
86 M progressive symmetric HL –> MC HL
conductive high-frequency HL
hard time F>M voices
42 F cough x 3w, fatigue, sore throat, nasal congestion, low grade fever, no SOB, dramatic fits, post-tussive emesis, no smoking, no immunizations, excessive lacrimation, conj injection, nL CXR –> dx
pertussis
- lasts weeks
- post-tussive emesis
- lacrimation
- conjucntival inj
- nL CXR + exam
2 F walking with mild in-toeing, next best step?
reassurance
48 F 2 cm darkly pigmented macule on forearm, IRR shape, variation color, enlarging –> next best step
excisional biopsy with 1-2 mm rim of nL appearing skin
25 F acute pelvic pain x 5d, sexually active, tenderness and fullness of R side –> imaging
transvaginal US = best initial study of F pelvic pain
also BhCG lab
38 M father CRC, when begin CRC screening?
40 yo
OR
10 y younger than earliest age onset
(whichever is first)
41 M HTN, HLD severe pain R toe
gout
tx acute gout attack
- NSAIDs (naproxen 500 mg BID OR indomethacin 50 mg TID)
- colchicine if first 12-24 h
- STOP HCTZ
