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COMATs > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

What is the definition of a reactive nonstress test?

A

2 accelerations within 20 minutes with or without fetal movement detected by the patient.
Preformed in patients who Present with decreased fetal movement

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2
Q

what is the definition of a non-reactive nonstress test?

A

Lack of 2 accelerations over 40 minutes of continuous fetal heart monitoring=> further evaluation needed
Presence of repetitive variable deceleration or deceleration that last for over 1 minute during a NST is considered non-reassuring and often necessitates cesarean delivery.

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3
Q

Of the follow drugs switch one decreases potassium levels: albuterol, amlodipine, loser tan, simvastatin, tamsulosin?

A

Albuterol- increased potassium uptake by the cells.

Other helpful drugs in hyperkalemia states are:
Insulin (give with glucose)
Loop diuretics
Intestinal cation exchange resins
Sodium bicarbonate
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4
Q

What is the initial tissue sampling technique of choice for a patient with a raised, superificaial non-pigmented lesion most consistent with non melanoma skin cancer

A

Shave biopsy- collect the dermal layers necessary for Dx

Punch bx for melanoma

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5
Q

What is on the diffdx and what is the next best step?
3 yo F acute onset of fever, sore throat, difficulty swallowing, and muffled speech. Vitals: 103.1 fever, HR 125, RR 30, BP 100/65. Appearance: anxious, leading forward wit ha hyperextended neck. Speaks in muffled voice and drooling. Inspiration strider and tenderness to palpation over her anterior neck.

A

Epiglottitis- h. Influenzae b infection
Thumb sign on X-ray

Endotracheal intubation
ABC’s

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6
Q

Based on the pt present what is her diagnosis and how do you confirm it?
54 yo F cc chest pain and SOB since her husband died 5 days ago. She is health. Meds- low dose aspirin. Vitals 37.1, HR 102, BP 88/60, RR 28, O2 sat. 99%, normal lipids. ECG: T wave inversion in lead V4-V6.

A

Takotsubo cardiomyopathy=> transient left ventricular dyskinesia, mimics Acute coronary syndrome.
Needs a two-step echocardiogram showing a symptomatic deficit in left wall motion followed by return to physiologic wall motion in 1-4 wks

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7
Q

What is the nemonic for depressive symptoms and what does it stand for?

A

SIGECAPS

Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal,

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8
Q

A pt has symptoms of DKA. What is the most crucial in the development of the this patient’s disorder?

A

DM type 1 is autoimmune

FHx of other AI Dx is crucial ex: vitiligo, lupus, Graves, Vasculitis, pernicious anemia, and IBD)

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9
Q

31 yo F G1P0 present for 16 wk appointment. She missed her 12 wk and has not had a US. Her serum AFP is 3x normal. Why?

A

Multiple gestation

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10
Q

How can you confirm diabete mellitus?

A

Fasting glucose of greater than or equal to 126 on two separate occasions
Hgb A1c greater than or equal to 6.5% on two separate occasion
2-hr post oral glucose tolerance test >200
Plus symptoms

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11
Q

_____ _____ is the complete disruption of all uterine layers occurring before, during or after childbirth.

A

Uterine rupture
— a risk factor is Hx is c-section( trail of labor after cesarean delivery), uterine surgery
— new on set pain b/w contractions,vaginal bleeding, and fetal heart rate changes

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12
Q

_______ _ ____ ____ ___ block, is due to a disturbance in conduction distal to the AV node, most often within the HIS-purkinje system.

A

Type 2 Second degrees AV block ( Mobitz II), intermittent non-conducted P-wave without a QRS complex, but PR is consistent

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13
Q

What are the tumor marker for germ cell cancer, malignant breast glandular cells cancer, GI tract (pancreatic, gall bladder/biliary duct, gastric cancer), and ovarian cancer, and colorectal cancer?

A

Germ cell=AFP
Malignant breast glandular cell= Caner antigen 15-3
GI tract= CA19-9
Ovarian= CA125
Colorectal=CEA (carcinoembryonic antigen)

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14
Q

What is the different between fibroadenoma of the breast and fibrocystic breast disease?

A

Fibroadenoma are the MC benign breast neoplasm in women presenting with a solitary, painless, well-circumscribed,rubbery and mobile breast mass. Composed of stroma and epithelial elements and MC found in young W

Fibrocystic breast disease is the MC cause of breast masses in W and presents B/L breast lumps and pain in the upper outer uadrants starting within several days of or prior to menstruation and disappearing after menstruation.

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15
Q

What is the A1c goal in elderly patients with a life expectancy of less than 10 years, and with multiple medical comorbidites?

A

8%

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16
Q

What are the recommended vaccinations for pt with AIDs( CD<200)?

A 
Inactivated influenza annually
To/TdaP every 10 yrs
HPV 3 dose series
Pneumococcal polysaccharide or 13-valent conjugate once
Hep B full series
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17
Q

What vaccinations are Contraindicated in all HIV pt?

A

Bacillus anthracis
Small pox
Zoster( shingles) vaccine

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18
Q

What vaccinations are contraindicated in pt with a CD4+<200?

A

Varicella vaccine

Measles, mumps, rubella

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19
Q

What is the antibiotic of choice for outpatient prophylactic treatment of uncomplicated animal bite wounds?

A

Amoxicillin-clavulanate

Beta-lactate plus beta-lactamase inihibitor

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20
Q

What is Naegele’s rule?

A

Estimated due date= for pt with regular 28 day cycles, add 7 days to the first day of their last menstrual period and add 9 months

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21
Q

What should all children and adolescents aged 6-17 yo be screened for?

A

Obesity
— BMI > 95th
—recommendation for children include 60 min/day of moderate aerobic activity( 6-17yo)

22
Q

What are the screening interventions recommended in adolescent populations? (3)

A

Obesity
Depression
Skin cancer

23
Q

What are the exercise recommendation for adults 18-64yo?

A

150 minutes per week of moderate aerobic activity
—or 75 min. Per week of vigorous aerobic activity
—anaerobic (weighting-lifting) recommendation 2x

24
Q

What are the MCV, iron, ferritin, and TIBC levels in a pt with anemia of chronic disease?

A

Low MCV
Low iron
High ferritin
Normal total iron-binding capacity

25
Q

What are Samter’s Triad?

A

Asthma, nasal poly poses, and aspirin intolerance => aspirin-exacerbated respiratory disease
Diagnosis is made with an oral challenge test with aspirin

26
Q

What is the most common EKG finding in patient with a pulmonary embolism?

A

Sinus tachycardia

The more specific PE EKG find is S-waves in lead I, q-waves in lead III, and inverted T-waves in lead III (S1Q3T3), however this is not the MC EKG finding

27
Q

What does an EKG with diffuse ST segment elevation and PR interval depressions without T-wave inversion most likely indicate?

A

Pericarditis

28
Q

What is the difference between Conduct disorder and oppositional defiant disorder?

A

Both conduct disorder and ODD features child that are defiant, hostile behaviors towards authority figures present for at least 6 months.

Conduct disorders includes violation of the right of others and social Norms and aggressiveness towards animals and people. Setting fires, destroy property

29
Q

How are infants born with meconium present managed?

A

Expectant management- infants born in the presence of meconium that are vigorous and w/o respiratory distress
Nasogastric suctioning: necessary to remove meconium from the stomach after intubation and endotracheal suctioning
Intubation and endotracheal suctioning: infants born with meconium present and who are not vigorous at delivery
Intubation if HR <60 bpm despite Positive pressure ventilation

30
Q

How do you treat a corneal abrasion?

A

Discontinuation of contact lens use, disposal of previous lenses, avoidance of eye patching, and the use of an anti-pseudomonas ophthalmic antibiotic (fluoroquinolne or aminoglycosides)

Ciprofloxacin- in contact wearers
Polymyxin B/trimethoprim eye drop maybe used in non-contact lens wearers with corneal abrasions

31
Q

_______ ______ _____ is the most appropriate next step in diagnosis for patients presenting with Claudication and other sx of peripheral arterial occlusive Dx.

A

Ankle- Brachial index: a calculation that is performed by dividing the measured systolic BP at the ankle of the affected limb(s) by the systolic BP in the arm. Normal is 0.9-1.1, <0.9 =PAOD
After ABI=> angiography

32
Q

What is the appropriate amount of weight gain during a pregnancy for someone with a BMI of 18.5-24.9?

A

25-35 lbs
— decrease risk of c-section, intrauterine growth restriction, and postpartum obesity
If the women is obese= 10-20 lbs gain
If the women is underweight= 35-45 lbs

33
Q

What do you treat temporal arthritis with?

A

IV methylprednisolone

34
Q

________ ______ is the most common cause to child intoeing?

A 
Internal tibia torsion
—MC usually a child 18 mon-3yrs
—causing are due to intrauterine positioning, sleeping prone, and sitting of feet
—commonly B/L, but if U/L=L
— usually resolves by 8 yo
35
Q

Describe the prevention protocol for GBS in pregnant women.

A

—test every women at 35-37 week for GBS
—if positive give penicillin (unless delivering via c-sections and dont have ruptured membrane)
—In Women w/ unknown status: give prophylaxis if
1.. prolonged rupture of membranes (>18hrs)
2. Intrapartum tempture (.100.4)
3. Immediate delivery to preterm labor (<37 wks)
4. PPROM

If 5 wks post sccreening= rescreen
If previous baby infected with GBS alway give prophylaxis

36
Q

What screening test are indicated for 20 yo women?

A

BP and chlamydia

37
Q

Described the recommendation for Chlamydia screening.

A

All sexually active women aged 24 and younger
All pregnant women aged 24 and younger
All women aged 25 and older who are at increased risk due to a hx of chlamydia infections, inconsistent condom use, multiple sexual partners, or spouse/partner infidelity

38
Q

What are the screen methods for congenital dislocation of the hip?

A

Ortolani and Barlow Tests
—ortolani= gripping femur, flexing the leg at the hip at 90, and applying posterior pressure toward the acetabulum;+ clunking
—Barlow= add addiction

Referral to ortho

39
Q

How do you diagnosis a spontaneous bacterial peritonitis (SBP)? (6)

A 
Ascites
Fever, chills
Jaundice 
abd. Pain
Tenderness and fluid wave on PE

Dx: paracentesis with fluid analysis that reveals a neutrophil count > 2.5 g/dL
Rx: Antibiotic= 3 gen cephalosporin such as cefotaxime or comb treatments w/ aminoglycoside (gentamicin) and ampicillin

40
Q

Which of the following precludes the use of HbA1c for accurate monitoring of glycemic control? Low (6), high (3)

A

High:
—Chronic kidney disease
—anemia due to deficiency of vit. B12, folate, or iron
—AA, Hispanic, or Asian

Low:
—SCD
—acute blood loss
—hemolytic anemia
—EPO therapy
—Chronic renal failure w/ hemodialysis
— B12, iron, folate
41
Q

What is CHARGE syndrome?

A 
Mutation in the CHD7 gene
—Coloboma
—Hear anomalies
—Cohan always atresia 
—growth retardation
—genital anomalies
—ear anomalies 
HX= intrauterine growth retardation, difficulty feeding die to Chantal atresia, facial clefting, dystrophin features, deafness and FTT
42
Q

What are risk factors to considered for new born brachial plexus injuries?

A 
Multiparity
Large for gestational age
Maternal diabetes
Previous child w/ it
Shoulder dystocia
Prolonged second stage of labor
43
Q

How do you treat pt presenting w/ moderate to sever asthma exacerbation?

A

Oral corticosteroids

44
Q

What is the Dx of a baby presenting with grunting and straining while urinating, Failure to thrive and/or urosepsis? How is that Dx confirmed?

A

Posterior urethral valves

Dx w/ voiding cystourethrogram

45
Q

What are the recommendation for AAA screening?

A

All men receive a 1x screening b/w 65-75
All women receive a 1x screeinging b/w 75-85

If aortic measure b/w 4-5.4cm; rescan in 6-12 mon
If aortic measure at 5.5com; elective surgical repair
If b/w 3-4 cm F/U in 2-3years

46
Q

What scenarios are the use of antibiotics indicated in acute otitis media?

A

Patient under 6 mons
Patient aged 6 mon-2yrs wi/ sx that are highly suggestive of bacterial otitis media (rapid onset, sign/sx of middle ear inflammation, and signs of middle ear effusion)
Pt aged 6mon-2yrs w/ severe illness (fever-102.2)
Pt 2 yo w/ sx highly suggestive of bacterial infection and severe illness
Pt who will be lost at F/U

47
Q

What should happen to a women who is taken levothyroxine and gets pregnant?

A

Increase dose of levothyroxine

  • prevent cretinism (mental retardation, growth restriction, and neuropsychological deficits)
  • Monitor TSH every 6-8 weeks and every trimester
  • Initial TSH 5 weeks
48
Q

Describe immune thrombocytopenia purpura.

A

AI platelet disorder in which antibodies against platelets lead to platelet clearance, resulting in thrombocytopenia
-acute: child after a viral infections
-chronic: women 20-40 yo
Cc: bleeding secondary to thrombocytopenia; petechiae, purpura, mucosal bleeding
Rx: corticosteroid, IVIG, IV anti-D

49
Q

How do patient with coal cord dysfunction present?

A

Vocal cord dysfunction will present w/ non-productive cough, strider, wheezing and dyspnea
Differentiated from asthma by spirometry merry, which reveals flattening of the inspiration loop and a normal FVC and FEV1/FVC ratio
Abnormal addiction during the inspiration phase of respiration resulting in laryngeal obstruction

50
Q

What is reactive airways dysfunction syndrome?

A

Pt with no previous respiratory complaints develops an asthma-like pulmonary response after a single, discrete inhalational exposure
—inflammatory infiltration of the airway with neutrophils being the predominant inflammatory cells causing edema and epithelial flattening with regeneration

51
Q

What is chorioamnionitis?

A

It is an intra-amniotic bacterial infections caused by ascending infection within the vagina. Dx: clinically with a combination of maternal fever, tachycardia, uterine tenderness, and fetal tachycardia

52
Q

Von willerand disease is a defect in what?

A

Clot formation and coagulation cascade

COMATs (3 decks)

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