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family medicine Flashcards

1
Q

how can hyperthyroidism cause secondary htn?

A

thyroid hormone->dec SVR->inc HR->inc CO->inc SBP

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2
Q

what are the cardiovascular effects of hyperthyroidism

A
  • dec svr, inc hr, inc CO–>isolated systolic hypertension
  • atrial fibrillation
  • pulmonary htn
  • congestive HF
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3
Q

what are the fundoscopic findings in a pt with htn

A

cotton wool spots (soft exudates)-occlusion of precapillary arterioles that supply the NFL–>ischemia->swelling of the NFL

arteriovenous nicking-narrowing of the retinal veins at the AV crossing

flame hemorrhages

hard exudates

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4
Q

hypertension physical exam what are you looking for

  • thyroid
  • lungs
  • heart
  • abdomen
  • lower extremities
  • neuro
A

thyroid-nodules, enlargement–>signs of hyperthyroidism a sign of secondary htn

lungs-crackles, dec breathe sounds, sign of CHF from long-standing htn

heart-inc HR, inc PMI (cardiomegaly), murmurs

abdominal-aortic bruits, pulsations, masses

lower extremities-pulses (PT, DP), lost of extremity skin, cold skin, thick toenails

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5
Q

criteria to diagnose htn

A

measure bp in each arm 5 minutes apart on 2 separate office visits

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6
Q

what % of people in the us are now considered hypertensive

A

45.6%

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7
Q

best htn drug for CKD. what is the target BP

A

ACEI or ARB–> block efferent arteriole constriction->inc GFR

goal: 130/80

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8
Q

best htn drug for Blacks

A

Thiazide diuretics or CCB are first line

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9
Q

for diabetics

A

No preference for the starting drug

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10
Q

htn drug options for the general population

A

Thiazides, Ca channel blockers, ARBs/ACEI,

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11
Q

What are the overall 1st line htn drugs

A

Thiazides (esp chlorthalidone #1)
Ca channel blockers
ACEI
ARBs

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12
Q

what is the target BP for all classes of htn

A

130/80

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13
Q

stage 1 hypertension

A

130-139; 80-89

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14
Q

stage 2 hypertension

A

140-159; 90-99

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15
Q

neuropathy prevalence is defined as

A

loss of ankle jerk for both type 1 and 2 DM
7% at 1 yr
50% at 25 yrs

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16
Q

which pain med is better for osteoarthritis, nsaids or acetaminophen

A

acetaminophen bc of better safety profile even though its not as effective

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17
Q

what is the appropriate dosing for acetaminophen

A

up to 4 grams divided up (short term)

up to 2-3 grams divided (long term)

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18
Q

most effective nsaid for osteoarthritis

A

diclofenac

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19
Q

side effects of nsaids

A

aki, hypertension, GI bleeding

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20
Q

details about intra-articular steroids for rx of osteoarthritis

A

-up to 3 per year
-consider when knee jt is inflammed (swelling, pain)
-short term benefit, few adverse SE
-

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21
Q

how should intra-articular steroid injections be administered

A

1 mL steroid with 3-4 mL anesthetic
Triamcinolone>methylprednisone
keep knee immobilized for 24 hours, but avoid prolonged immobilization

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22
Q

Glucosamine, chondrointin, plasma rich platelet, hyaluronic acid injections are

A

unlikely to provide substantial benefit for osteoarthritis

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23
Q

is acupuncture beneficial for osteoarthritis

A

mixed evidence, may provide short term benefit

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24
Q

which opioid can help rx osteoarthritis

A

Tramadol

  • for older pts with moderate/severe pain
  • lower abuse potential than other opioids
  • lowers seizure threshold=Tramadol==tremors
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25
Q

what supplement has an anti-inflammatory effect to help with joint pain

A

omega 3 fatty acids

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26
Q

Medial or laterally directed patellar taping is conditonally recommended for pts with knee arthritis

A

Medial patellar taping only

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27
Q

USPTF guidelines: Abdominal aortic aneurysm screening

A

A one-time ultrasound to screen for an abdominal aortic aneurysm (AAA) is recommended in men 65 to 75 years old who have any history of smoking, but the USPSTF recommends against routine screening for AAA in women.

28
Q

USPTF: hypertension

A

18 and older should be screened for elevated bp

29
Q

usptf: colon cancer screening

A

age 50-75

  • colonoscopy q 10 yrs
  • sigmoidoscopy-only detects L sided colon cancer
  • fecal occult blood test: can’t detect colon polyps
30
Q

USPTF: excercise

A

recommend exercise age 65+ to prevent falls

31
Q

USPTF guidelines: screening for childhood obesity

A

start at age 6 (Grade B)

32
Q

% of kids btwn 6-19 who are overweight

A

15%

33
Q

the evidence is poor, fair, or good that overweight kids 8 and older are at increased risk of being obese adults

A

FAIR evidence

34
Q

dx of adhd

A
  • dx no earlier than age 6
  • sx last at least 6 months
  • sx of inattention and of hyperactivity/impulsive:
  • at least 6 sx or 5 sx after age 17
  • symptoms interfere with life, present in 2+places (home, school), sx present b4 age 12,
35
Q

compare nonasthmatic eoisinophilic bronchitis with asthma

A
  • responds to inhaled corticosteroids like asthma
  • normal spirometry, normal chest xray
  • dx: induced sputum or bronchoscopy sample showing eosinophilia
36
Q

initial evaluation of asthma should include what 4 things

A
  1. severity of asthma
  2. surrounding =environmental triggers
  3. skills and knowledge of pt for self-management
  4. support-offer appropriate medications
37
Q

a cochrane review found that acarisides (insectiside that kills dust mites) and extensive bedroom based environ. control programs are effective at reducing what

A

allergic rhinitis–a comorbid condition of asthma

*not effective at controlling asthma though

38
Q

best meds for allergic rhinitis

A

seasonal mild allergic rhinitis-nasal corticosteroids

seasonal mod/severe rhinitis-nasal corticosteroids+oral antihistamine

*allergy shots improve sx and dec medication dosage needed for both asthma and allergic rhinitis

39
Q

most concerning effect of long term uncontrolled asthma

A

decreased reversibility of airway obstruction

40
Q

Centor criteria

A

Criteria for likelihood of strep, whether to proceed with rapid strep test

C-cough absent +1
E-exudate +1
Nodes +1
T-Temp>38 (100.4) +1
OR
-age less 14 +1
-14 to 45        0
greater 45     -1
41
Q

which risk factor causes the most deaths in the US

-obesity, smoking, diabetes, htn

A

SMOKING

42
Q

3 leading causes of smoking attributable death

A

lung cancer>ischemic heart disease->copd

43
Q

_____is the single largest risk factor for cardiovascular mortality

A

htn

44
Q

bmi>32
bmi of 30-35

bmi>40

A

double mortality rate of women over 16 yrs
reduces life expectancy by 2-3 yrs

reduces life expectancy of men by 20 yrs, women by 5 yrs

45
Q

name of the criteria for DVTs

A

Well’s criteria for DVTs

  • low probability: 0 or less
  • moderate probability:1-2
  • high probability: >3
46
Q

For DVTs
-best predictive value (high sens, high specif)
-

A
  • doppler ultrasound: expensive (high sens, high speci)
  • D dimer test: protein fragment in the blood after thrmbus is degraded by fibrinolysis (high sens, low specif)–>rules out DVT if negative
47
Q

Describe the classification system for ulcers

A

Wagner classification (DRUDGE)

48
Q

Describe the classification system for ulcers

A

Wagner classification (DUDGE)

Grade 1-Diabetic ulcer (superficial)
Grade 2-Ulcer extension (ligament, tendon, jt capsule, fascia)
Grade 3-Deep ulcer with abscess or osteomyelitis
Grade 4-Gangrene of forefoot (partial)
Grade 5-Extensive gangrene of foot

49
Q

Ulcer management

  • Grade 1 and 2
  • Grade 3
  • Grade 5
A

Grade 1-2: outpatient management, wound debridement, relief of pressure, if infected (prurulent exudate, erythema) treat

Grade 3: partial hospitalization, eval for osteomyelitis/PAD prior to treating the ulcer

Grade 5: urgent surgery eval, amputation likely

50
Q

some pts can manage DVTs outpatient. which ones need inpatient management

A
  • can’t afford NOACs and LMWH
  • cant get daily INR checks
  • hemodynamically unstable (prior admission for GI bleeding)
51
Q

why does warfarin admin first require admin with heparin

A

warfarin takes several days to reach therapeutic level, this is not ok, so we start LMWH then bridge to warfarin

52
Q

what are NOACs

A

non vit k anticoagulants

  • factor X inhibitors: rivuroxiban, atixiban
  • can be admin as monotherapy
  • pros: no lab monitoring needed, fewer bleeding episodes than warfarin
  • cons: expensive, no reversal agent for bleeding
53
Q

which is preferred for management of PEs and DVTs

A

-factor X inhibitors: argatroban, rivuroxiban»»warfarin

54
Q

discuss direct thrombin inhibitors for managing PEs and DVTs

A

digabatran-must be overlapped with heparin bc hasn’t been studied as monotherapy

55
Q

compare LMWH to unfractionated heparin

A

LMWH

  • longer t1/2, can admin subcut 1-2x/day
  • monitoring not req (can use outpatient)
  • less risk of bleeding
  • dosing is fixed
  • dec risk of thrombocytopenia

UFH

  • req monitoring (must use inpatient)
  • shorter t1/2, better to use than LMWH in pt with risk of GI bleeding
56
Q

what is the recommended duration of anticoagulation for first time PE, DVT

A

3 months no matter for all scenarios except….

-except if pt has underlying clottting disorder (protein c) or cancer pt–>indefinite length of time

57
Q

benefits of hormone replacement therapy

A
  • cognition, mood
  • atrophic vaginitis (dyspaerunia)
  • dec osteoporosis
  • improves urinary sx (incontinence)
58
Q

should you choose hormone replacement therapy for a woman to treat only osteoporosis

A

NO, bc USPTF reccommendation is D

59
Q

what are the risks of using HRT

A
  • for the first 1-2 years, inc risk of STROKE
  • starting after age 60, inc risk of CAD
  • combined E and P after 3 years–>inc risk of breast cancer
  • unapposed E in females with a uterus–>endometrial cancer
60
Q

USPTF mammogram screening

A

every 2 years from 50-74

61
Q

USPTF colon cancer screening

A

50-75

  • colonoscopy q 10 yrs, use for family hx, hx of polyps, abnormal bowel changes
  • Stool DNA+fit test q 1-3 yrs
  • sigmoidoscopy q 5 yrs
62
Q

cervical cancer screening

A
  • 21-30 q3 yrs
  • 30-65 co-testing q 5 years or pap (cytology alond) q 3 years

*screening is not indicated for women in their 50s w/o risk factors

63
Q

risk factors for endometrial cancer

A

htn, obesity, THYROID DISORDERS, diabetes, breast and colon cancer

  • unappposed estrogen
  • tamoxifen (SERM-Nolvadex)–>estrogenic effect on the uterus
64
Q

Which panels should be checked for menopausal women with AUB

A
  • thyroid panels-TSH. assoc with inc risk of endometrial ca
  • FSH, LH: wil be inc in women in menopause
  • TVUS-sensitive, cheap. <4 mm–>non-concerning
  • CBC: rule out anemia, thrombocytopenia
  • endometrial biopsy
65
Q

what is the single best predictor of low bone mineral density

A

weight<70kg

family medicine (1 decks)

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