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VLC x Raphaelle > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

Name the A Fib categories associated with the following time frames: (1) <7 days, (2) >7 days and requires treatment, (3) lasts longer than 12 months, (4) patient always in A Fib.

A

(1) Paroxysmal (ends in 7 day with or without intervention )\n(2) Persistent AF (does not end in 7 days and requires treatment)\n(3) Long–standing persistent A.Fib (lasts more than 12 month)\n(4) Permanent AF (persistent Afib no longer rhythm control)

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2
Q

What are the treatment implications of Valvular vs Non Valvular A Fib

A

Valvular A Fib ––> use warfarin

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3
Q

List at least three conditions associated with A Fib.

A

HTN, CAD, ETOH abuse, CHD, Valvular heart disease, Hyperthyroidism, Surgery

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4
Q

A Fib is generally an incidental finding, but what symptoms can a pt present with?

A

SOB, CP, Palpitations, fatigue, weakness, dizziness,lightheadedness

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5
Q

List two A. Fib ECG findings

A

(1)Lack of p waves, and (2) irregular r–r interval

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6
Q

List three A Fib echocardiogram findings

A

Left ventricular dysfunction and left ventricular hypertrophy, and valvular disease

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7
Q

What lab test should be ordered for pt with a fib?

A

TSH and T4

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8
Q

Three treatment goals in A Fib

A

Prevent stroke, control rate, control rhythm

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9
Q

List two drug classes for rate control in A Fib

A

Beta blockers, non–dihydropyridine Calcium Channel Blocker

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10
Q

List 3 treatments for rhythm control in A Fib

A

Antiarrhytmic Drugs (amiodarone), Electrical, Surgical

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11
Q

Which 2 factors should be considered for risk stratification in chronic coronary syndrome?

A

(1) Family history (MI <65 in women, <55 in men), (2) Exercise stress testing results

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12
Q

If an A Fib patient is high risk based on the stress test, what is the next step?

A

Coronary angiography and revascularization

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13
Q

List 4 drugs used in anti–anginal therapy (not treatments for slowing disease progression)

A

Beta blocker (reduces risk of second MI)\nCCB \nNitrates\nRanolazine (symptomatic relief in men)

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14
Q

List 3 treatments for preventing A Fib progression

A

(1) Antiplatelet (use SPARCtool to determine which is appropriate)\n(2) High dose statin\n(3) Manage risk factors (150 minutes exercise each week, mediteranian diet, smoking cessation, controling DM and HTN)

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15
Q

What is the normal range for HDL

A

> 1.5 in women, >1 in men

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16
Q

What is the normal range for LDL

A

<3.5

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17
Q

What is the ‘SPARC Stroke Prevention in Atrial Fibrillation Risk Tool’ estimate?

A

(1) risk of stroke in a fib pt and (2) benefits & risks of antithrombotic therapy in a fib pt

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18
Q

When does lipid screening start in primary care?

A

Age 40 or earlier if risk factors (e.g., Smoking, HTN, DM, family history of premature CAD, CKD, stigmata of dyslipidemia)

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19
Q

Should you order fasting or non fasting lipids?

A

Non–fasting

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20
Q

What does Framingham risk score (frs) evaluate the risk of?

A

10 year risk of MI

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21
Q

What next step is required for a person with an FRS <5%

A

Screen every 5 years

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22
Q

What next step is required for a person with an FRS >5%

A

screen every 1 yr

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23
Q

What is appropriate treatment for a person with an FRS >10

A

Health Behavioural Modifications

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24
Q

When should you consider a statin (in addition to lifestyle changes) in a person with FRS of 10–19%? \nNB: an FRS of 10–19 suggests an intermediate risk.

A

If they have an LDL>3.5 or additional risk factors

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25
Q

Who should receive a statin for primary prevention in chronic coronary syndrome? What degree of LDL lowering should be the goal for this population?

A

(1) Those with FRS >20% (2) those with Genetic dyslipidemia and and LDL>5.\nAim for 50% reduction of LDL from baseline

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26
Q

Pts with which conditions should receive secondary prevention with a high intensity statin? There are 4 conditions.

A

(1) Clinical Artherosclerosis \n(2) Abdomnial Aortic Aneurysm \n(3) DM: age>40 OR age>30+15y T1DM, OR Microvascular disease \n(4) Chronic Kidney Disease

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27
Q

What online tool should we use for managing A Fib?

A

SPARCtool.com

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28
Q

What three things should you think about in managing a pt with chronic coronary syndrome?

A

(1)Risk stratify, (2) determine pts ability to exercise for a stress test, (3) assess the availability of a cardiac lab and how soon you can access service.

29
Q

When it comes to statins, what does the Framingham risk score often show?

A

Shows that most people do not need statin for primary prevention

30
Q

What six screening assessments for the elderly have clear benefits? \nHint:\nStart with B, I, F, V, M, F

A

BP\nImmunization: flu, tdap+ pertussis, varicella zoster, pneumococcal\nFracture risk \nVision\nMedication assessment\nFall risk

31
Q

DEATH (ADLs)

A

dressing, \neating, \nambulating, \ntoileting, \nhygiene

32
Q

SHAFT (IADLs)

A

shopping, \nhousekeeping, \naccounting, \nfood prep, \ntelephone

33
Q

What does the Clinical Frailty Tool predict?

A

hospitalization and death

34
Q

What three questions can be asked to screen for falls?

A

“Have you had 2 or more falls in the past 12 months?” \n “Did you just have an acute fall?” \n “Do you have difficulty with walking or balance?”

35
Q

List at least 4 intrinsic risk factors for falls, 7 were listed in lecture.

A

Pain\nDecreased mobility\nMeds/ polypharmacy\nIncontinence\nLow vision\nDementia\nComorbid chronic conditions

36
Q

List the four components of a falls exam

A

Gait: antalgic, loss of heel strike and toe off\nMedication review (pharmacist)\nCognitive Assessment (OT)\nFunctional Assessment (OT)

37
Q

List five conditions on the differential for cognitive impairment in the elderly

A

Normal aging\nMild cognitive impairment\nDepression\nDelirium\nDementia

38
Q

How can delirium be differentiated from dementia?

A

Time course: delirium lasts hours to days and fluctuates

39
Q

Delirium mnemonic: I WATCH DEATH. What does I WATCH stand for?

A

Infections\nWIthdrawal\nAcute metabolic (etoh, benzos, sedative–hypnotics)\nToxins/drugs \nHypoxia (anemia, low BP, pulmonary or cardiac failure)

40
Q

Delirium mnemonic: I WATCH DEATH. What does DEATH stand for?

A

Deficiencies in thiamine (etoh abuse), B12\nEndocrine (thyroid, blood sugar, adrenal insufficiency, hyperparathyroid)\nAcute vascular (shock, hypertensive encephalopathy)\nTrauma (head injury, post op)\nHeavy metal

41
Q

What are the two main causes of delirium, according to Dr. Yu–Hin Siu

A

Pain and medication

42
Q

Cognitive Impairment Assessment

A

Onset and progression \nMedication review \nFocus on function: ADLs (DEATH), IADLs (SHAFT) \nRule out the mimics (Depression and delirium)

43
Q

Labs in cognitive impairment work up

A

CBC, \nElectrolytes, \nTSH, \nSerum calcium (with albumin), \nFastingglucose (or HbA1c), \nB12 level

44
Q

When would you do a CT for cognitive impairment? There are 10 situations, think of 4.

A

Age <60 \nRapid decline in cognition or function over 1–2 mo \nDuration of Dementia < 2 years \nRecent head trauma \nNew unexplained neurologic or localizing signs \nHistory of cancer \nUse of anticoagulants or a history of bleeding disorder \nHistory of gait disorder or urinary incontinence early in dementia (NPH) \nAtypical cognitive symptoms or presentation \nCurrent gait disturbance

45
Q

What lifestyle changes can you discuss with the patient and family in order to minimize the impact of dementia?

A

Treat systolic hypertension in older individuals \nAssess for polypharmacy\nSafety (driving**, wandering, etc)

46
Q

List three things that would trigger you to investigate a patients ability to drive safely?

A

Increased traffic violations and accidents\nFamily or patient concern\nForgetting routes or rules of the road \nAn equivocal score on cognitive testing \n“Would you let your 2 year old in his/her car?”

47
Q

What acronym can cue you to driving risk factors?

A

CANDRIVE \nCognition, \nAcute/Fluctuating Illness, \nNeurologicissues, \nDrugs, \nRecord, \nIn–Car experiences, \nVision,\n ETOH use

48
Q

With regards to dementia, when do you have a duty to report a driver to the MTO?

A

When you have any safety concern, regardless of MOCA scores.

49
Q

What is a key components of a goals of care conversation?

A

The need to legally select a power of attorney.

50
Q

What is a good website for supporting advance care planning

A

planwellguide.com

51
Q

What service is essential to bring in early in disposition planning? How early?

A

Bringing the LHIN 3–4 years before the patient feels they will be ready to enter a home. They can be put on a list, but if a bed comes up they can say no.

52
Q

What are the stages of symptom management in palliative care?

A

Assess the symptom, \nTreat the underlying cause if appropriate\nIf not, treat the symptom non pharmacologically, or pharmacologically

53
Q

What are the 6 As of pain assessment?

A

Activities of daily living\nAggravating \nAlleviating \nAssociated \nAddiction \nAnalgesia

54
Q

10 mg oral morphine is equivalent to___ hydromorphone

A

2 mg Hydromorphone

55
Q

How should you convert an oral opioid dose to injectable?

A

Divide by two

56
Q

Name two weak opioids and three strong

A

Weak: codeine, tramadol\nStrong: hydromorph, oxycodone, morphine

57
Q

Non pharm management of dyspnea

A

Table fan\nProp up in bed/ lean forward\nLarge room with windows\nAvoid activities\nMeditation and breathing techniques

58
Q

Pharmacological treatment for dyspnea

A

Low dose opioids (Morphine 2.5 – 5 mg PO q4hrs)\nBenzos if anxiety is causing or caused by dyspnea\nO2 if patient is hypoxic

59
Q

What are some signs and symptoms of death coming within weeks? Name 3.

A

Fatigue leading to ongoing bedrest\n Different sleep–wake patterns \nLittle appetite and thirst \nMore pain\nChanges in blood pressure, breathing, and heart rate\nBody temperature ups and downs that may leave their skin cool, warm, moist, or pale \nCongested breathing from the buildup in the back of their throat \nConfusion or seem to be in a daze \nBreathing trouble \nHallucinations and visions

60
Q

What are some signs and symptoms of death coming within days or hours? Name 3.

A

Not want food or drink\nStop peeing and having bowel movements \nEyes tear or glaze over \nPulse and heartbeat are irregular or hard to feel or hear \nBody temperature drops \nSkin on their knees, feet, and hands turns a mottled bluish–purple (often in the last 24 hours) \nBreathing is interrupted by gasping and slows until it stops entirely \nUnconscious, drifting in and out of consciousness\nTerminal delirium\nRespiratory secretions (Death rattles)

61
Q

med for pain

A

SQ opioids

62
Q

Dyspnea medication

A

SQ opioid

63
Q

Delirium medication

A

SQ low dose Haldol

64
Q

Nausea and Vomiting medication

A

Haldol or Metoclopramide (prokinetic)

65
Q

Anxiety medication

A

Sublingual lorazepam or SQ midazolam

66
Q

Respiratory secretion medication

A

SQ scopolamine

67
Q

Mouth care

A

artificial saliva gel. spray

68
Q

What steps are involved in the pronouncement of death

A

Wait 30 minutes\nCheck ID bracelet and radial pulse \nCheck pupils for position and response to light \nCheck response to tactile stimuli \nCheck for spontaneous respiration \nCheck for heart sound and pulses \nRecord time of death

69
Q

What are some good examples of what should be put down as the immediate cause of death? Bad examples?

A

Good examples: sepsis, pulmonary embolism, cardiac arrhythmia. \nBad examples: “cardiac arrest”, “systemic multi–organ failure” or generic diagnoses such as “old age”.

VLC x Raphaelle (7 decks)

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