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Family Medicine Flashcards

1
Q

What’s Fagerstroms test?

A
  • Tests nicotine dependence
  • Score helps determine whether nicotine replacement therapy (NRT) is needed (patches, gums etc)
  • Score of 3-4 = treatment with one NRTI, Score over 4 = several NRTI
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2
Q

What is Schneider test?

A

Test for evaluating motivation for quiting smoking.

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3
Q

Medications for quiting smoking:

  1. First line?
  2. Second line?
A
  1. First line: Buroprion or Varenicline (Buproprion+naltrexone also possible)
  2. Nortriptylene or Clonidine
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4
Q

The 5 A’s of smoking intervention?

A
  1. Ask (about smoking)
  2. Advise (on quitting)
  3. Assess (readiness to quit)
  4. Assist (with smoking cessation)
  5. Arrange (follow-up visit)
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5
Q

What’s the SCORE system charts?

A

A way to assess 10-year risk of dying from a cardiovascular disorder

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6
Q

What are the 2 types of SCORE charts and how do they differ?

A
  1. SCORE low risk
  2. SCORE high risk

They differ based on the country they are used for (norway is low risk, and poland is hight risk)

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7
Q

Which variables are taken into account when using the SCORE charts? (5)

A
  1. Age
  2. Gender
  3. Total cholesterol
  4. Systolic Blood Pressure
  5. Smoking status
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8
Q

Which other system is the SCORE system often contrasted with?

A

Framingham criteria (det samme som NORRISK 2)

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9
Q

Main difference between SCORE and Framingham?

A

SCORE decides 10-year risk of DEATH fro CVD, while Framinghame decides 10-year risk of GETTING a CVD

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10
Q

3 important preventable risk factors for CVD?

A
  1. Lowering Cholesterol
  2. Controlling BP
  3. Quitting smoking
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11
Q

Lowering cholesterol

  • 1st line treatment?
  • 2nd line treatment?
A
  • 1st line: lifestyle modifications (weight loss, less saturated fats…)
  • 2nd line: statins, esp atorvastatin or rosuvastatin
    • SCORE 7.5-10%: Moderate-dose statins (e.g atorvastatin 20mg x1)
    • SCORE >10%: High-dose statins (e.g atorvastatin 40-80mg x1)
    • Remember: anyone >4.9 mmol/L LDL gets a statin
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12
Q

When do we usually screen for hyperlipidemia?

A
  • Men > 35y
  • Women > 45y
  • At-risk patients: 20-35y
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13
Q

Blood pressure control

  • 1st line treatment?
  • 2nd line treatment?
A
  • 1st line: Lifestyle modifications, low-sodium intake, DASH diet, weight loss, less alcohol intake
  • 2nd line: antihypertensive drugs
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14
Q

Hypertension:

  • Forhøyet BT
  • Grad 1 HT
  • Grad 2 HT
  • Grad 3 HT
A
  • Forhøyet: 130 - 140 Systolisk og/eller 80-90 Diastolisk
  • Grad 1: 140 - 160 Systolisk og/eller 90-100 Diastolisk
  • Grad 2: 160 - 180 Systolisk og/eller 100-120 Diastolisk
  • Grad 3 (HT urgency): >180 Systolisk og/eller >120 Diastolisk
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15
Q

Når vi behandler noen for HT, hvilket blodtrykk er det generellet målet vi ønsker å oppnå?

A
  • Pasient under 80 år: < 140/90mmHg
  • Pasient over 80 år: 140-150/90 mmHg

OBS! vurdere lavere blodtrykk ved tidligere hjerneslag

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16
Q

Hvordan bestemmer vi hvilken grad HT pasienten er?

A

Når blodtrykket måles skal man gjerne måle 3 ganger og bestemme gjennomsnittet av de 2 siste gangene, gjerne mål begge armer for å utelukke arterosklerose

  • Ved mistanke om Grad 1 skal blodtrykket skal egentlig måles ved 2-3 konsultasjoner over en observasjonsperiode på 3-6mnd og evt. verifiseres med ambulatorisk blodtrykk
  • Ved mistanke om høyere enn grad 1 (>160/100) skal observasjonstiden forkortes
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17
Q

Så vi har bestemt grad av HT, hva er indikasjon for behandling?

A

NORRISK 2 er et godt hjelpemiddel når vi vurderer behov for start av legemiddelbehandling

  • Start behandling uavhengig av NORRISK 2 dersom:
  1. Diabetes
  2. Grad 2 eller 3
  3. Familiær Hyperlipidemi eller Hypercolesterolemi (untatt kvinner >50)
  4. Påvist organskade (e.g arterosklerose, nyreskade, LV hypertrophy)

Når pasienten ikke har ovenevnt kan vi bruke NORRISK 2 til å vurdere

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18
Q

Når indikerer NORRISK 2 for behandling av Grad 1 HT?

A

Husk at NORRISK 2 gjelder kun for alder 45 - 75, utenom dette må det vurderes individuelt

  • Alder 40 - 50: behandling ved risk > 5%
  • Alder 50 - 60: behandling ved risk > 10%
  • Alder 60 -75: behandling ved risk > 15%
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19
Q

Primær Hypertension behandling?

A

Ved fravær av effekt under Trinn 1, prøv deg litt om med enten opptitrering eller bytte preparat, du kan velge mellom ACE/AGII- blokker, Kalsiumblokker eller Tiazid-diuretika.

Bare husk: ALDRI gi ACE-hemmer med AGII-blokker, du skal velge mellom dem!

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20
Q

Vi har startet å en pasient på monoterapi og vurderer kanskje gå videre til Trinn 2, når er dette indikert?

A

Når pasient på monoterapi har mer enn 20/10 over ønsket mål (altså BT > 160/100) eller ved varende HT symptomer

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21
Q

Hva slags kalsiumblokkere brukes ved behandling av primær HT? Når brukes den andre typen?

A
  • Dehydropyridines brukes ved behandling av primær HT
  • Non-dehydropyridines brukes KUN ved sekundær HT med atrieflimmer uten hjertefeil
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22
Q

I hvilke tilfeller er B-blokkere ansett blant førstevalg medikamentene i HT behandling? (2)

A
  1. HEFrEF
  2. Etter MI
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23
Q

Hvilket antihypertensiva bør man unngå når man behandler pasient med urinsyregikt for HT? Og i såfall, hva er anbefalt behandling for HT pasient med hyperuremi?

A

Hovedsakelig Tiazider (øker urea og bør derfor unngås), men også ACE-hemmere, B-blokkere og visse AGII antagonister har visst tegn til å kunne øke urea.

  • Beste behandling for HT med hyperuremi, er Kalsiumblokkere + Losartan (eneste AGII-blokker som derimot reduserer urea)
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24
Q

HT behandling av HEFrEF pasient?

A

Her er HT sekunder og vil normaliseres når pasientens HEFrEF er tilstrekkelig behandlet:

  1. ACE - hemmer
  2. Ved varende symptomer og EF < 35% (NYHA II-IV) legg til aldosteron-antagonist (spironolactone eller eplerenone)
  3. Ved varende ødem eller dyspnè legg til loop diuretika
  4. Ved utilstrekkelig effekt opptitrer ovenenvnte medikamenter
  5. Ved fremdeles utilstrekkelig effekt, bytt ut ACE-hemmer med ARNI (Entresto)

Vi vet bahndlingen hjelper når EF forbedres, symptomer lindres og NYHA reduseres

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25
Hvilke faktorer tar vi i betraktning når vi vurderer astma-nivå? (4)
1. Generelle anfallssymptomer: wheezing, dyspne, chest tightness, coughing 2. Hyppighet av anfall (antallet ganger per måned eller uke, vedvarende symptomer utover dagen etc...) 3. FEV1 (\>80, 80-60, \<60....) 4. FEV1/FVC ratio (normal, reduced 5%, reduced \>5%)
26
Annet enn hovedbehandlingen hvilke tiltak skal man ellers ta hos hjertesvikt pasienter? (5)
1. Maks daglig vann inntak 1500ml 2. Reduserr saltinntak 3. Vei daglig og juster medikamenter ved \>2kg vektøkning ila. 1-3 dager 4. Ved atrieflimmer, pass på at pasienten er på blodfortynnende, hvis ikke sett han på Albyl-E 75mg x1. Vurder også behov for arytmibehandling med digoxin etter regime (konf med overordnenede først) 5. Ved angina kan pasienten få nitrater om Systolisk \> 100mmHg
27
What are Centor criteria?
A set of criteria used to distinguish strep throat from other pharyngitis
28
How is Centor criteria set up and how does the modified version look like?
Each criterion gives +1 point: 1. Absence of cough 2. Tonsillar exudates 3. History of fever 4. Tender anterior cervical lymph nodes The modified version includes age where +1 point for age \<15 or -1 point for age \>44.
29
What does the score from Centor criteria mean? * -1 to 1 points? * 2-3 points? * 4-5 points?
Scoring determines best clinical action * -1 to 1 points: Risk \< 10%, no swab or ABx necessary * 2-3 points: Risk 15% (2) or 32% (3), use throat culture, ABx if positive * 4-5 points: Risk 56%, rapid strep test, ABx if positive NPV is better than PPV so best for ruling out strep throat
30
What's The Beck Inventory?
* A screening tool for depression * 21 question test where each can give 0-3 points based on the answer * Range from minimal (0-9) to severe depression (30-63 points)
31
2 alternatives to the Beck Inventory?
1. Beck Depression Inventory for Primary Care (BDI-PC), a shorter 7-point version 2. PHQ-9, a short questionaire based on 9 questions
32
What was SIG E CAPS again?
* **S**leep changes (more or less) * **I**nterest loss (less interest of previous pleasurable activities) * **G**uilt (worthlessness) * **E**nergy decrease (lack of energy) * **C**oncentration decrease (decreased concentration/cognition) * **A**ppetite loss/gain * **P**sychomotir increase or decrease (anxiety or lethargy) * **S**uicidality (thoughts or attempts)
33
In which neurodegenerative disease is depression most common?
Parkinson's disease
34
Non-pharmacologic treatment of MDD? (2) Pharmacologic treatment of MDD? (4)
* Non-Pharm: 1. Physical activity and healthy diet 2. Psychotherapy (CBT and interpersonal therapy) * Pharmacologic: 1. SSRI 2. SNRI 3. TCA 4. Antipsychotics (if there's psychotic depression)
35
Signs that someone might have a secondary hypertension? (6)
1. Resistant hypertension, i.e. if BP is not lowered by 3 typical BP lowering agents 2. Acute rise. If the patient was recently normotensive and suddenly has a high one 3. Age less than 30 years, without relevant risk factors (e.g. obesity, fam. Hx) 4. Malignant hypertension 5. Electrolyte disturbances 6. Onset before puberty
36
Causes for Secondary Hypertension? (7)
1. Renovascular (most common), e.g. renal artery stenosis 2. Kidney disease 3. Primary hyperaldosteronism 4. Sleep apnea syndrome (obesity!) 5. OCPs (women of childbearing age) 6. Cushing’s (typically diastolic increase) 7. Pheochromocytoma
37
Definition of heart functions * Normal * HFpEF * HFmrEF * HFrEF
* Normal \> 50% without markers or structural changes * HFpEF \> 50 % with high pro-BNP and LVH or LAE (diastolic dysfunction) * HFmrEF 40-50% with same as above * HFrEF \< 40%
38
How is EF measured?
* By using echo * LV at end-diastole - LV at end-systole * although these days we mostly use modified Simpson's rule calculated by the machine
39
What's the NYHA classification?
* NYHA I: HF without it affecting physical activity (no symptoms during physical activity) * NYHA II: HF with small effect on physical activity (only symptoms with high physical activity) * NYHA III: HF affecting even small physical activity (patient must stay relaxed to not get symptoms) * NYHA IV: HF affecting even relaxed patients (symptoms even when relaxed)
40
Causes for CHF? (6)
1. Ischemic heart disease (those with CAD, often are post-MI) 2. Hypertension (the higher it is, the worse - alters remodeling of LV) 3. LV hypertrophy (often due to HT, DM, valvular disease etc...) 4. Previous valvular surgery 5. Dilated cardiomyopathy (due to pregnancy, alcohol, cocaine, doxorubicine...) 6. Metabolic syndrome (not a direct etiology though)
41
What's metabolic syndrome?
A combo of of HTN, DM and obesity
42
I hvilke tilfeller er B-blokkere ansett blant førstevalg medikamentene i HT behandling? (2)
1. HEFrEF 2. Etter MI
43
HT behandling av HEFrEF pasient?
Her er HT sekunder og vil normaliseres når pasientens HEFrEF er tilstrekkelig behandlet: 1. ACE - hemmer 2. Ved varende symptomer og EF \< 35% (NYHA II-IV) legg til aldosteron-antagonist (spironolactone eller eplerenone) 3. Ved varende ødem eller dyspnè legg til loop diuretika 4. Ved utilstrekkelig effekt opptitrer ovenenvnte medikamenter 5. Ved fremdeles utilstrekkelig effekt, bytt ut ACE-hemmer med ARNI (Entresto) Vi vet bahndlingen hjelper når EF forbedres, symptomer lindres og NYHA reduseres
44
What kind of finding is typical in CHF patients with etiology of ischemic heart disease?
Often related to CAD and thereby may often have ha hibernating myocardium that may become active again after good revascularization (PCI/angioplasty, CABG....statins, blood thinners and nitrates are also an option)
45
Erythema Infectiosum * Other name? * Caused by? * Signs and symptoms? * Treatment? * Complications?
* Other name: Slapped Cheek Syndrome * Caused by Parvovirus B19 * Signs and symptoms: * Commonly seen in children * Fever and rash at the same time * Characteristic rash on both cheeks (backhanded baby) * Supportive treatment, passes on its own * Complications: * Aplastic anemia, esp. in sickle cell patients * Hydrops fetalis in pregnant females
46
Measles * Caused by? * Symptoms? * Characteristics? * Treatment? * Complications?
* Caused bay Paramyxovirus, spread by droplets * Symptoms: * Incubation 7-14 days * Rash starts on face and spreads down * Fever * Characterized by 4C's * Cough * Coryza (runny nose) * Conjuctivitis (runny red eyes) * Coplic (Koplik) spots (white spots on oral mucosa) * Treatment: Supportive, can be prevented by MMR vaccine at early age * Complications: can stay dormant for many years and later in life subacute sclerosing panencephalitis
47
How does a measles rash look like?
48
Why is Rubella often called German Measles? And how do we mainly differ Rubella from measles?
Cause the rashes in rubella may look similar to measles, but differ in being more mild, but spreads faster than measles (remember rubella is much less dangerous than measles!) Although we mainly differ Rubella from measles by looking at other signs than the rash or fever. Mainly we know it's Rubella if we can rule out the 4C's of measles and look for typical Rubella symptoms
49
Rubella * Incubation time and spread? * Symptoms? * Treastment? * Complications?
* 11-21 days incubation, spreads by droplets * Symptoms: * Lymphadenopathy * Forchheimer spots (red spots on palate) * Mild rash that spreads quickly * Treatment mainly supportive, can be prevented by MMR vaccine at early age * One of the TORCH diseases (causes birth defects in pregnant women)
50
Coxsackie A virus infection * Other name? * Symptoms? * Prevention? * Treatment?
* Also called "Hand-foot-mouth disease" * Symptoms: * As the name suggests, blisters/spots on palms, soles and mouth (inside and out) * Typical mild virus infection sx like fever and malaise * No preventive vaccine * Treatment: Steroids might ease the symptoms, esp, mouth blisters when eating
51
Roseola * Cause? * Symptoms? * Treatment?
* Caused by HHV-6 * Symptoms: 1. Starts with very high fever (\>40C) that spikes then disappears 2. Rash appears after fever and that starts in the trunk then spreads outwards (face, limbs etc...) * Treatment:
52
Two types of diseases caused by the VZV?
* When young: Chickenpox * When older: Herpes Zoster
53
Varicella Zoster Virus infection * Incubation time and spread? * Symptoms? * Treatment?
* Incubation of 11-21 days, spreads by droplets and contact * Symptoms: * No fever * Herpetiform rash with lesions at different stages of healing that itches and hurts (some have vesicles, the vesicles may have popped or scabbed over) * In Herpes Zoster the rash is confined to dermatomes and hurts alot! (shingles) * Treatment: goes by itself, can be prevented by MMR(V) vaccine, Acyclovir within 24h ogf onset may shorten symptoms, gabapentin or pregabalin for pain
54
How does VZV come back as Herpes Zoster later in life?
After an infection at early age (chickenpox), the virus can stay dorment within the nerves for many years, it usally only comes back as HZ if the patient becomes immunosuppressed later in life (old age, HIV, cancer etc...)
55
How does chickenpox rash look like?
56
How does Herpes Zoster rash look like?
57
Mumps * What causes it? * Who typically gets it? * Symptoms? * Complications? * Treatment?
* Caused by the Mumps virus * Occurs typically in prepubertal males * Symptoms: swollen cheecks (parotitis), swollen testes (orchitis) * May cause infertility * Supportive treatment, prevented by MMR vaccine in early age
58
How does mumps look like?
59
Erysipelas * Caused by? * Rash? * Other symptoms? * Main demographic? * Treatment?
* Caused by Strep.pyogenes (often after something breaks the skin like insect bite, trauma, surgery or other infections) * Rash: Red, swollen, warm and painful rash, with sharp marked edge * Other symptoms include typical bacterial-infection symptoms like fever, chills and fatigue * Main demographic are immunosupressed patients + DM, alcohol, impaired lymphatic drainage etc... * Treated with penicillins
60
Erysipelas vs Cellulitis pathological difference?
61
Erysipelas vs Cellulitis, rash difference?
62
Impetigo Contagiosa * Caused by? * Rash? * Treatment?
* Mainly caused by staph, but may also be caused by strep * Rash: begins as a red sore near mouth or nose, that later breaks open and leaks out pus causing a honey-coloured crust, later becomes a red patch that resolves without scarring * Treatment: topical antiseptics or antibiotics like Mupirocin ointment, can also give orla ABx if severe
63
How does impetigo contagiosa rash look like?
64
Boils * Dermatological name and presentation? * Caused by? * Demographic? * Treatment?
* Also called "furuncle"; red, bumpy pus-filled lumps around hair follicles that are often warm and painfull * Caused by staph aureus * Found in immunosuppressed and malnourished patients * Treatment: * Can be surgically drained * Antibiotics (if thepatient is immunosupressed, has a lump \>5mm and are at risk of endocarditis, make sure the antibiotic works on MRSA)
65
How do boils look like?
66
Oral thrus/candidiasis * Caused by? * Signs? * Demographic? * Treatment?
* Caused by Candida spescies (found on normal skin flora) * Signs: white coating of the tongue * Demographic: immunocompromised patients and babies \< 1 year * Treatment: Nystatin (mycostatin) for oral or topical miconazole gel when on skin
67
Scabies * Where do they come from? * Signs? * Who gets treated? * Diagnosis? * Treatment?
* Often come from cloth-material like towels and bedding etc... in clothes settings like homeless shelters, daycares etc... * Signs include: * Strong itching that worsens when warm or at night * Track marks on **wrists**, elbows genital, abdomen, flanks, but etc... * Both the patient and people they've been in contact with must be treated * Diagnosed mainly on clinical signs, but one can take a microscopy * Treatment: * First-line: ivermectin (if itchin stops later, it's propably scabies) * Permethrin is also a good option * Antihistamines and other antiinflammatories may also help + wash clothes at 60C
68
How does Scabies look like?
69
Warts * Caused by? * Medical treatment? * Treatment procedures?
* HPV * Medicine: 1. Salicylic acid (melts it) 2. Imiquimod (incr. immune respone) 3. Bleomycin (cytostatic) * Procedures: * Electrodesiccation (electric scalpel cuts it off) * Cryosurgery (liquid nitro) * Laser treatment * Surgery
70
Acne Vulgaris Treatment?
Chronological order from non-inflam to severe-inflam: 1. Non-inflam: Retinoid cream 2. Mild-moderate: Benzocyl Cream with retinoid or ABx cream 3. Severe: Oral ABx with retinoid cream 4. Severe nodular: Isotretinoin kaps (bad for liver, controll LFT's)
71
Vaccine types? (4)
1. Live attenuated 2. Killed vaccines 3. Purified macromolecule vaccine 4. DNA/RNA vaccine
72
73
Live Attenuated Vaccines * What are they? * Which of them are there? (7) * Who should avoid them? (3)
* These use a weakened form of the germ that causes the disease * MMR(V), Yellow fever vaccine, rotavirus vaccine, influenza vaccine * Shpuld be avoided by: * Pregnant people * Immunocompromised people * People with first-line relatives that are heredetary immunocompromised
74
What are Killed vaccines (inactivated vaccines)?
A version of the germ that cannot replicate (unlike live vaccines)
75
Types of Purified Macromolecule Vaccines? (3)
1. Inactivated toxins vaccines 2. Conjugate vaccines (combine weak antigen with strong antigen -\> better response to weak antigen) 3. Subunit vaccines (only the specific antigen)
76
Contraindications for vaccines?
* LAV not given in pregnancy or immunocompromised * Previous allergy to the vaccine * Allergy to one of it's byproducts (e.g eggs in flu vaccine) * Current acute illness (relative contraindication)
77
MMR vaccine * Absolute contraindication? * Relative? (3)
* Absolute: it's LAV, so keep away from pregnant or immunocompromised * Relative: 1. Recent (\<11mo) admin of antibody-containing blood product 2. Thrombocytopenia 3. Current need for TB testing (measles vaccination might suppress tuberculin skin test)
78
Varicella vaccine * Absolute contraindication? * Relative? (2)
* Absolute: it's LAV, so keep away from pregnant or immunocompromised * Relative: 1. Recent (\<11mo) admin of antibody-containing blood product 2. Use of specific antiviral drugs (valacyclovir, famciclovir)
79
Influenza Vaccine * Absolute contraindications? (5) * Relative? (3)
* Absolute: 1. it's LAV, so keep away from pregnant or immunocompromised 2. Salicylate-containing drugs (aspirin) in children+adolescents 3. Kids 2-4yo with history of wheezing past 12mo or asthma diagnosis 4. Close contact with immunocompromised patients 5. Influenza antivirals in the past 48h. * Relative: 1. Guillain-Barre syndrome (GBS) within 6 weeks of previous vaccine 2. Asthma in persons \>5yo 3. Other major chronic medical conditions
80
Polio vaccine * Type? * Relative contraindication?
* Type: Killed vaccine (inactivated vaccine) * Relative: Pregnancy (cat B2- no proven side-effect, but lack of studies)
81
Relative contraindication of HPV vaccine?
Relative: Pregnancy (cat B2- no proven side-effect, but lack of studies)
82
DTaP, Tdap, DT, Td (diptheria, pertussis and tetanus in various combinations) * Absolute contraindication for ALL? * Relative contraindication for ALL? * Relative contraindication esp. for DTaP and Tdap?
* Absolute: Encephalopathy within 7d of previous pertussis vaccination * Relative: GBS within 6 weeks after previous tetanus toxoid vaccine * + Relative for DTaP & Tdap: Progressive neurological disorder
83
Hep B vaccine * Absolute contraindication? * Relative contraindication?
* Absolute: Yeast allergy * Relative: Infant \< 2kg
84
Preferred injection site for LAV?
Deltoids! | (not enough coverage in glutes)
85
Varicella vaccination schedule?
* First at 12-18month old * Boster at 4-6y
86
MMR vaccination schedule?
* First at 13-14 months * Booster at 10y
87
Other than varicella and MMR, which vaccines often given \<16 months? (6)
1. Hep B 2. BCG (tuberkulose) 3. DTaP 4. Pneumococcal 5. H.Influenza type B. 6. Polio?
88
Tetanus vaccine * How long does it last? * Most common types?(3) * Who gets the booster?
* Effect lasts 10 years * Common: DTaP (mix), Td (booster), immunoglobulin vaccines * Booster is recommended for: * Adults every 10 years * Women during each pregnancy
89
When someone gets tetanus when do they usally start to show symptoms?
Usually within 8 days, some may also get them as early as within 3 days or as late as within 21 days
90
Procedure for what vaccine to give if someone comes in with a tetanus-risk wound?
91
What to do if you get an adult that's not previously vaccinated for tetanus?
3 doses: * Give a vaccine * Give a booster after 4 weeks * Then the last dose 6-12 months later
92
Rabies vaccine * Type? * Who gets it?
* Killed vaccine, there's also an immunoglobulin vaccine that one can add to the regimen for stronger effect, but it's not necessary * Not a part of vaccine regimen, only given if traveling to areas with high rate (pre-exposure regimen) or after exposure (post-exposure regimen)
93
Pre-exposure regimen for Rabies vaccine? What about post-exposure?
Pre-exposure is 3 doses: * First dose * 1 week later: Second dose * 3-4 weeks later: Third dose Post-exposure requires one dose + maybe additional immunoglobulin vaccine injected on wound site
94
Asthma * Definition? * Age of presentation? * Commonly linked to \_\_\_?
* Def: A disease of chronic, reversible airway inflammation, characterised by periodic attacks of wheezing, shortness of breath, chest tightness, and coughing * Age: usually at \<10yo * Commonly linked to triggers (e.g smoking, medicine, dust, allergens, exercise, virus etc)
95
Hvilke faktorer tar vi i betraktning når vi vurderer astma-nivå? (4)
1. Generelle anfallssymptomer: wheezing, dyspne, chest tightness, coughing 2. Hyppighet av anfall (antallet ganger per måned eller uke, vedvarende symptomer utover dagen etc...) 3. FEV1 (\>80, 80-60, \<60....) 4. FEV1/FVC ratio (normal, reduced 5%, reduced \>5%)
96
Annet enn hovedbehandlingen hvilke tiltak skal man ellers ta hos hjertesvikt pasienter? (5)
1. Maks daglig vann inntak 1500ml 2. Reduserr saltinntak 3. Vei daglig og juster medikamenter ved \>2kg vektøkning ila. 1-3 dager 4. Ved atrieflimmer, pass på at pasienten er på blodfortynnende, hvis ikke sett han på Albyl-E 75mg x1. Vurder også behov for arytmibehandling med digoxin etter regime (konf med overordnenede først) 5. Ved angina kan pasienten få nitrater om Systolisk \> 100mmHg
97
Astma Trappetrinn behandling? (6)
1. \< 2 symptomer i måneden: SABA ved behov 2. \> 2 symptomer i måneden: Lav-dose ICS, og SABA ved behov 3. Sytmptomer flest ukedager: Lav-dose ICS-LABA, og SABA ved behov (alt. medium-dose ICS og SABA ved behov) 4. Daglige symptomer: Medium-dose ICS-LABA og SABA ved behov (alt. Lav-dose ICS-LABA med tillegg av LTRA eller Triotropium, SABA ved behov) 5. Alvorlige Symptomer: Høy-dose ICS-LABA og vurder tillegg av Omalizumab, SABA ved behov 6. Veldig Alvorlige symptomer: Høy-dose ICS-LABA med orale kortikosteroider, samt vurder tillegg av omalizumab, SABA ved behov
98
Classification of Asthma Severity (intermittent-mild-moderate-severe)?
99
100
How common is BPH and who's its demographic?
About 50% of men at age 50 and 80% of men age 80 have lower urinary tract symptoms (LUTS) due to BPH
101
2 categories of BPH symptoms?
* Storage symptoms (can't stor much urin): 1. Increased daytime frequency, 2. Nocturia 3. Urinary incontinence * Voiding symptoms (can't pee easily): 1. Urinary stream is either slow, splitting, spraying or intermittent 2. Hesitancy and straining to void (takes time to start peeing) 3. Terminal dribbling (mye i rest, så tar tid å bli helt ferdig) Micro-or macroscopic hematurie may also sometimes occur
102
Diagnosis of BPH?
1. Signs and symptoms 2. Direct Rectal Examination reveal enlarged, firm, nontender prostate 3. BPH?
103
Is BPH a risk for prostate cancer?
No!!! BPH is a benign process, the only reasons to treat it is if it reduces quality of life, or causes bladder outlet obstruction (BOO)
104
Score system for assessing how problematic a BPH is?
IPSS: International Prostate Symptom Score
105
How does IPSS look like?
106
Possible tratment options for BPH?
Many are asymptomatic and only need to be observed without treatment! * Medical (no BOO, mild-moderate IPSS): 1. a1-inhibitor: Tamsulosin, Doxazosin, Terazosin 2. PDE5-inhibitor: Sildenafil, Taldanafil etc... (slow) 3. 5a-reductase-inhib: Finasteride, Dutasteride (slow) * Surgica (BOO): * TURP (transuretheral resection of prostate)
107
How common is Prostate cancer?
3rd most common cancer death worldwide, 1st most cancer death common in men
108
Lifetime risk of getting prostate cancer and lifetime risk of dying from it?
Lifetime risk of diagnosis – 15%, lifetime risk of death – 2-3%
109
Risk of having some type of prostate cancer at age \> 70?
70% risk at age \>70y
110
Why is older age related with higher risk of prostate cancer, but also related with decreased chance of dying from it?
Cause you're more likely to die from something else at that age
111
Is PSA high in BPH or Prostate cancer?
It can be high in both
112
How usefull is PSA for detecting prostate cancer? What about Digital Rectal examination for diagnosing prostate cancer?
* PSA:Not really usefull * Sensitivty of 70% and a PPV of 40%, meaning that you can have prostate cancer even with low PSA * DRE: Not that usefull either * Sensitivty of 59% and PPV of 5-30% Frrom previous trials it has shown that PSA and DRE increase chance of diagnosis, but not the chance of detection (in other words: many false-positives)
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What is PSA mostly usefull for? (2) And who are the tests recommended for? (2)
* Usefull for: * Determining progression of BPH (monitor PSA and if it increases further, the BPH might be worse), THIS IS THE MAIN USE OF PSA * Combined with DRE to rule out prostate cancer in LUTS patients * Intended for: 1. Those with at least a 10-year life expectancy and for whom knowledge of the presence of prostate cancer would change management 2. Those for whom the PSA measurement may change the management of their voiding symptoms”
114
Malignant Melanoma * What is it? * What are the most common types? (2)
* A cancer of melanocytes * Most common types: 1. Superficial Spreading Melanoma (60-70%) 2. Nodular Melanoma (30%)
115
Which patients is PSA NOT usefull for? (2)
1. Asymptomatic patients! 2. Prostate cancer patients where PSA lvl won't change management option
116
Risk factors for melanoma? (10)
1. Numerous moles 2. fair skin (Fitzpatrick I and II) 3. Red hair 4. Positive personal/family history 5. 1 large congenital nevus (\>20 cm) 6. Familial dysplastic nevus syndrome 7. Any dysplastic nevi 8. Immunosuppression 9. \> 50 common nevi 10. Sun exposure with sunburns and tanning beds In other words, it's risky for white people with many moles and that commonly go tanning
117
If patient comes in with suspicious mole, what can you ask them to do for further observation?
Ask them to observe for changes at home, maybe take a picture of it from time to time to observe progression
118
ABCDE checklist for for assessing possible melanoma?
119
Diagnosis and treatment of melanoma, first step?
Exicsional biopsy, send biopsy for analysis
120
Basal Cell Carcinoma (BCC) * How common is it? * What kind of cancer is it?
* Most common skin cancer * Kancer of basal keratinocytes of the epidermis
121
Morphology of BCC?
* Several subtypes with varying morphology ‒ the cells (over)produce keratin, this is reflected in the appearance of the various subtypes * Often described as “shiny”, “pearly”, “scaly” * Often has a name that reflect additional features ‒ noduloulcerative (typical), pigmented, superficial, sclerosing.
122
Metastasis and progression of BCC?
Usally grows aggressively **sideways**, so metastasis isn't common
123
Cause of BCC?
UVB radiation, which is why it's common on face
124
Treatment options for BCC? Cure reate?
Depending on depth of invasion: * Surface lvl: 1. Imiquidin cream 2. Cryotherapy 3. On the trunk: Shave excision and courettage 4. On the face: Mohs surgery * Deeper invasion: Radiotherapy or surgery * Metastasis: Vismedogib 95% cure rate if treated early or if lesion is small
125
Follow-up of BCC after treatment?
Lifelong! every 6-12months
126
Squamous Cell Carcinoma (SCC) of skin vs BCC?
SCC often looks like BCC, but differs in that it grows faster and vertically, often downwards, but may also grow upwards and make a horn
127
128
Which skin surfaces is SCC most often present on? (4)
Sun-exposed skin surfaces like: 1. Face 2. Ears 3. Scalp 4. Forearms and back of the hands
129
Risk factors for SCC? (5)
1. Chronic sun exposure 2. Radiation therapy/exposure 3. Certain carcinogens (arsenic, tar, nitrogen mustard) 4. HPV 16 and 18 5. Being male
130
What do you have to remember to do during examination of SCC (skin) patient?
SCC can metastasize fast, so do a a full lymph node examination and a full skin exam for other lesions (the wider and deeper SCC is, the more it has metastasized)
131
132
What's Bowen's disease?
SCC in situ (early stage), very treatable at this stage
133
Other name for Borrelliosis?
Lyme Disease
134
Where's Borreliosis from?
From Borrelia burgodrferi bacteria found in GI of Ixodes tick
135
Time window to remove tick before there's a chance of infection?
If you remove it within 48 hours there's no risk of infection. Doesn't matter if the teeth stay in, the infection is in the GI so you can let them stay and fall on their own.
136
Main skin sign of borreliosis? Other skin signs?
The main skin sign is **Erythema Migrans** (bullseye), apperas in 80% of patients and can appear up to 30 days after infection. Other skin signs include local lymph node enlargement and tenderness
137
Symptoms of early stage Borreliosis?
* Cardiologic: AV-block and myopericarditis * Neurological: Cranial neuropathy (Bells Palsy), meningitis and radiculoneuropathy
138
Late symptoms of borelliosis? (3)
1. Arthritis of small and large joints (only small joints recover) 2. Acrodermatitis chronica atrophicans - blue/red discoloration on back of hands and feet 3. Post-Lyme Syndrome (5-15%) - muskuloskeletal pain, recover within 6-12 months
139
How late can systemic symptoms of Borreliosis occur?
Can occurr as late as within weeks to months
140
Treatment of borreliosis(lyme disease)?
Penicillins or doxycyline
141
The different weight classes based on BMI?
* Underweight \<18.5 * Normal 18.5 - 25 * Overweight 25 - 30 * Obesity Class I: 30 - 35 * Obseity Class II: 35 - 40 * Extreme Obesity (Class III): +40
142
Other than BMI, what other measurement can we also do on examination?
Waist Circumference (WC) \>102cm in men is bad \>88cm in women is bad
143
Why is WC important to measure in obesity?
Cause central obesity is more dangerous than distributed obesity, I guess it means higher amount of visceral fat
144
BMI indication for pharmacotherapy in obesity? What do we use?
* \>27 BMI is indication for pharmacotherapy * Orlistat: a GI lipase inhibitor that reduce fast absorption by 30%
145
Contraindications for Orlistat?
IBS and IBD
146
Empiric ABx in COMPLICATED UTI?
Depends if there's risk factors or not (inpatient stay at hospital/nursing home/etc) * No risk factors: Ceftriaxone or Piperacillin-Tazobactam * \>0 risk factors: Carbapenems
147
2 types of Pneumonia?
1. Community-Aquired Pneumonia (CAP) 2. Nosocomial Pneumonia
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2 types of Nosocomial Pneumonia?
1. Hospital-Aquired Pneumonia (HAP), \>48h after hospital admission 2. Ventilator-Aquired Pneumonia (VAP), \>48h after ventilator
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CAP: typical bacteria? (5)
1. Strep.pneumo 2. H.influenzae 3. M.catarrhalis 4. Staph.Aureus 5. Group A strep
150
CAP: atypical bacteria? (4)
1. Legionella 2. Mycoplasma 3. Chlamydia pneumoniae 4. Psitacci
151
CAP: viral causes? (5)
1. Influenza A/B 2. Rhinoviruses 3. Parainfluenza 4. Adenoviruses 5. RSV
152
CAP: pulmonary symptoms? (5)
1. Cough 2. Dyspnea 3. Pleuritic chest pain 4. Tachypnea 5. Unusual breath sounds (rales, rhonchi)
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CAP: systematic symptoms?
Fever, chills, fatigue, malaise (general infection symptoms)
154
Most important part of pneumonia diagnosis?
Chest X-Ray!!!! Take Lateral and Frontal view, and look for infiltration
155
2 criterias you can use to assess the severity of pneumonia?
* CURB-65 (most common) * PSI (requires ABG)
156
Explain CURB-65
157
Usual treatment time of CAP and what's important to remember when considering to end treatment?
* Usual treatment 5-7 days * Should make sure patient has been afebrile and better AT \> 48h before ending treatment
158
Definition of Acute Bronchitis?
: Lower RT infection involving the large airways, WITHOUT evidence of pneumonia and NOT in the setting of COPD.
159
Microbial causes for Acute Bronchitis? (5)
Caused by viruses: 1. Influenza A/B (most common) 2. Parainfluenza 3. Coronaviruses 4. Rhinoviruses 5. RSV OBS! some of the above viruses are also associated with pneumonia
160
Diagnosis of Acute Bronchitis?
Cough \> 4 days and rule out pneumonia (signs and CXR)
161
Treatment of Acute Bronchitis?
* None, just let it pass by itself within 1-3 weeks, and be sure it's not pneumonia * Only ABx if caused by pertussis
162
Other than bronchitis and pneumonia, what other COMMON causes of cough? (7)
1. Covid! 2. Postnasal drip syndrome (harmless, usually after a cold) 3. GERD 4. Asthma 5. ACEi use 6. Pulmonary embolism 7. Lung cancer.
163
Can you use cold-medicine in Acute Bronchitis?
YES!
164
Piaget’s model of child development?
165
Definition of Sinusitis?
Symptomatic inflammation of the nasal cavity and paranasal sinuses
166
Cause of Sinusitis?
Mainly viral, but may also be bacterial (worse prognosis)
167
Common symptoms of Sinusitis? (4)
Much like a common cold 1. Headache 2. Feeling of heaviness 3. Purulent nasal discharge 4. Fever (mainly bacterial)
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Course of viral sinusitis?
Symptoms last 7-10 days and resolve by their own
169
Treatment of viral sinusitis?
Mainly symptomatic: Paracetamol/ibuprofen/etc for pain relief and antipyretic effect, decongestants may also be useful.
170
Course of bacterial sinusitis?
Symptoms last \>10 days and can be recurrent (resolves, then comes back)
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Other than common cold symptoms, what additional symptoms may be seen in bacterial sinusitis? (7)
Affects nearby structures 1. Persistent high fever 2. Periorbital inflammation/erythema 3. Cranial nerve palsies 4. Abnormal eye movement 5. Proptosis 6. Vision changes 7. Meningeal signs,
172
Treatment of bacterial sinusitis?
Mainly observation. If patient can't be observed or symptoms last \> 17 days (one week after 10 days) start Amoxicillin for 5 days
173
What happens in Acute Otitis Media?
Presence of fluid in the ear and inflammation of middle ear mucosal membranes
174
Who does Acute Otitis Media most often affect
Children! (short eustachian tubes)
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Most common symptoms of Acute Otitis Media?
Ear pain and decreased hearing
176
Diagnosis of Acute Otitis Media?
Otoscopy! * You can se a bulging tympanic membran * May be erythematous, yellowish or cloudy (indicate fluid) * If it ruptures you may see a discharge
177
How do we test for hearing loss in Acute Otitis Media?
Weber Test! Put on vertex of skull ans ask patient if they hear better in one ear (cause fluid emmit sound better than air, the affected ear will hear it better)
178
Other than Acute Otitis Media, other common causes for ear pain? (4)
1. Otitis externa 2. Ear trauma 3. Throat infections 4. Foreign body in ear or throat
179
Treatment for Acute Otitis Media?
Amoxicillin
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Complication of Acute Otitis Media? (5)
Can affect nearby structures 1. Mastoiditis (tenderness of mastoid process), 2. Spread to the brain 3. Facial nerve paralysis * Can be unresponsive to ABx (esp. if also mastoiditis?) * Can progress to Chronic Suppurative Otitis Media (refer to specialist)
181
What's the quality improvement assessment cycle?
A conceptual tool for improving standard of care
182
Explain the levels of the quality improvement assessment cycle
183
What's WONCA?
The World Organization of Family Doctors
184
Common risk factor for domestic abuse? Who turns most often to their GP about it?
* Alcohol abuse is a common risk factor for it, but not a direct cause * Mostly women turn to their GP about domestic abuse
185
Things to look for in domestic abuse? (3)
1. Injuries: bruises and broken bones 2. Identifying predisposing risk factors 3. Psychological signs: anxiety, panic attacks, stress and/or depression
186
How to speak with domestic abuse patient? (4)
1. _Listen_: Being listened to can be an empowering experience for a woman who has been abused 2. _Communicate belief_: "That must have been very frightening for you" 3. _Validate the decision to disclose_: "It must have been difficult for you to talk about this. I'm glad you were able to tell me about this today" 4. _Emphasise the unacceptability of violence_: "You do not deserve to be treated this way"
187
188
General symptoms suggesting cancer? (7)
1. Recurrent infections 2. Fever of unknown origin 3. Unexplained loss of weight/appetite 4. Tiredness, weakness 5. Nausea, vomiting 6. Chronic pain 7. Bleeding, anaemia, unexplained bruises
189
The 7 warning signs of cancer?
Mnemonic CAUTION * **C**hange in bowel or bladder habits * **A** sore that does not heal * **U**nusual bleeding or discharge * **T**hickening or lump in the breast, testicles, or elsewhere * **I**ndigestion or difficulty swallowing * **O**bvious change in the size, colour, shape, or thickness of a wart, mole, or mouthsore * **N**agging cough or hoarseness
190
Leading cause of cancer dath?
Lung cancer
191
Main risk factor of all 85% of cancer?
Smoking
192
Cancer risk comparing smokers to non-smokers?
Smokers have 20x cancer risk
193
Best screening methods for lung cancer? (2)
1. Chest CT (94% sensitivity) 2. Chest X-ray (60% sensitivity)
194
Number needed to screen to prevent 1 cancer death?
320
195
Screening recommendation for lung cancer?
Annual Chest CT for 55-80y with smoking history
196
Lifetime risk of developing colorectal cancer?
5%
197
90% of cases of colorectal cancer happen when?
At age \>50%
198
Diagnostic tests in colorectal cancer? (4)
1. FOBT (hemofec) 2. Sigmoidoscopy 3. Colonoscopy 4. CT colonography
199
Colorectal cancer, screening age and common methods?
* Age 50 - 75 * Methods: 1. FOBT every 2 years 2. Colonoscopy every 10 year
200
Most frequently diagnosed cancer in women?
Breast cancer
201
Lifetime risk of breast cancer in women?
Lifetime risk of 12%, increase with age, esp \>40yo and even more at \>60yo
202
Relative increase of breast cancer risk when there's a BRCA mutation?
Risk of breast cancer increases further by 10-32%?? (according to document, not sure if this is right)
203
What can we use to assess risk of breast cancer?
The breast cancer assessment tool (available online)
204
Ways of screening for breast cancer? (2)
1. Self examination 2. Mammography
205
Mammography * Sensitivity? * Spesificity?
* Sensitivity: 70% * Specificity: 90%
206
Risk of false-positive mammography?
23% (requires biopsy for further investigation)
207
Breast cancer screening recommendations?
Depends on the country, mammography every 2 years in either 40-74yo or 50-75yo
208
Rulse according to Wilson and Junger criteria for screening? (4)
1. _Knowledge of disease:_ Should be important health problem, must have a recognisable latent period or a disease marker, detectable risk factor, or early symptomatic stage 2. _Knowledge of test:_ Must be simple, safe, precise and validated. Distribution of test values in target population should be known and a suitable cutoff level defined. The test should be acceptable to the population 3. _Treatment:_ Effective treatment for patients identified through early detection, with evidence that early treatment is better than late 4. _Cost considerations:_ Should be balanced against expenditures on medical care as a whole.
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4 problems with disease screening?
1. Lead time bias ‒ patients whose diseases are detected earlier due to screening, appear to live longer, but this may be due to early diagnosis 2. Length time bias ‒ Screening is more likely to detect slower-growing tumours that may be less deadly, causing a better perceived survival 3. Overdiagnosis ‒ screening may detect abnormalities that may never have caused a problem) 4. Selection bias * At- risk patients get more screening so negative outcome from screen is morelikly for them * If a test is more available to young and healthy people, fewer people in the sample will have negative outcomes than in a random sample, the test will seem like it have positive outcomes * More sick people bein screened --\> increase true positive, more young people being screened --\> increase false negatives
210
What are the 2 methods of screening for a disease?
1. Opportunistic - test patients when they go to the doctor for something else 2. Systematic ‒ deliberately seek out all patients in a population
211
Recommended screening for cervical cancer?
Pap smear and HPV test at age 21-65 or 30-65
212
Percentage of geriatric patients with chronic disease?
80%
213
* Definition of comorbidity? * Percentage of geriatric patients with comorbidities? * Average number of comorbidties in geriatric patients?
* Comorbidity: having 2 or more chronic diseases * 50-70% of geriatric patients have comorbidities * Geriatric patients have on average 4-5 comorbidities
214
10 common comorbidities in geriatric patients?
1. Diabetes 2. Hypertension 3. CAD 4. AFib 5. HF 6. Lipid disorders 7. Vision disorders 8. Hearing loss 9. Depression 10. Cognitive impairment
215
COPD, classic presentation? (4)
1. Age \>40 2. Shortness of breath 3. Chronic cough (often 1st symptom) and/or sputum production 4. History of exposure to risk factors (smoking, occupational, indoor/outdoor pollution). 5. Symptoms are progressive over time, worsens with exercise and are persistent
216
Spirometry findings in COPD and Gold 1-4?
COPD: FEV1/FVC \< 0.7 AND decreased FEV1 that can help asess severity: * GOLD 1 \>80% * GOLD 2 50-80% * GOLD 3 30-50% * GOLD 4 \<30%
217
2 chronic disorders that may cause or worsen COPD?
1. a-antitrypsin 1 deficiency (panacinar emphysema) 2. asthma
218
Two main goals when treating COPD?
1. Relieve symptoms 2. Reduce risk of exacerbation
219
Important criteria we use to assess COPD symptom severity?
CAT score
220
Measures to take to reduce risk of COPD exacerbation? (3)
1. Smoking cessation 2. Physical activity 3. Vaccinations (flu, pneumococcal)
221
Recommended medication for COPD Gold 1 (or CAT \<10)?
SABA or SAMA
222
Recommended medication for COPD Gold 2 (or CAT \>10)?
LABA OR LAMA
223
Recommended medication for COPD Gold 3 (also if had \>2 exacerbations or a hospitalization in the past year)?
LABA or LAMA with ICS if ithat's not enough you can take all 3 at same time it still not enough, maybe exhange one of them for theophylline or PDE4I (just like in asthma)
224
CAT score of GOLD 4 COPD?
\>20
225
If a parent has alcohol/drug abuse, what's the chance that their child will have it as well?
8x chance increase!
226
Defiinition of Dependence?
Symptoms of increased tolerance and withdrawal
227
Definition of Addiction?
Addiction is marked by a change in behaviour, where the substance becomes a focal point of their lif
228
What's dyspepsia/indigestion?
Difficult digestion (nothing to do with swallowing!!!), there's a chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating.
229
Etiologies of dyspepsia?
Vary from idiopathic to stomach cancer, but * GERD is a common cause * Duodenal or gastric ulcers may also cause it * Gastric carcinoma only 1%
230
How should you approach a patient with dyspepsia?
1. Start ruling out non-GI causes: heart, lung, liver, GB, pancreas 2. Then rule out drugs that may cause it: aspirin/NSAIDS, CCBs, nitrates 3. After that you can start considering GI, and get an upper endoscopy
231
What's the Rome Criteria?
Used in diagnosis of functional gastrointestinal disorders. The newest version used today is Rome IV
232
Give examples of different Rome IV's out there? (8)
There are many more than these, but among other there's 1. IBS 2. Dyspepsia 3. Chest Pain 4. Biliary pain 5. Diarrhea 6. Constipation 7. Dysphagia 8. Rumination syndrome
233
ROME IV criteria for dyspepsia?
Symptoms must last \>3mo, with first symptom starting at least \>6mo ago 1. Bothersome post-meal fullness 2. Early satiety 3. Epigastric pain 4. Epigastric burning 5. No evidence of structural disease
234
Management of dyspepsia?
You can give antiacids. Other than that just lifestyle changes and healthy eating
235
What's IBS?
Functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits, in the absence of a specific and unique organic pathology, often psychogenic
236
237
Rome IV for IBS?
Abdominal pain at least 1/week in the last 3 mo, and with 2 of the following sx: * The abdominal pain is related to defacation * The abdominal pain is related to change in stool frequency * The abdominal pain is related to stool form (diarrhea or constipation?)
238
Warning signs that the patient you suspect of IBS might have something more serious? (5)
1. Unintended weight loss 2. Blood in stool 3. Symptoms that awaken the patient 4. Fever 5. Family history of CRC, IBD or celiac also look for anorexia, steatorrhea and bleeding
239
Diagnostic tests for ruling out other causes of IBS-symptoms? (6)
1. Studies: Ferritin, ESR, CRP to look for inflammation 2. Stool examinations for ova and parasites, C.diff toxin, Giardia antigen 3. Hydrogen breath test, to exclude bacterial overgrowth 4. Testing for celiac 5. T3, T4, serum Ca for hyperthyroidism 6. Calprotecting in stool for IBD
240
IBS treatment? (2)
* First line: special dietary changes to decrease symptoms * Symptom management (treat diarrhea or constipation)
241
Most common cause of arthritis?
Osteoarthritis
242
What's primary osteoarthritis?
Just wear and tear of the joints
243
10 causes for Secondary Osteoarthritis?
1. Inflammatory arthritis 2. Crystal arthropathy (e.g. gout) 3. Septic arthritis 4. Prior joint trauma or surgery 5. Endocrinopathies (acromegaly, hyperparathyroidism) 6. Metabolic disorders (haemochromatosis, ochronosis) 7. Neuropathic arthropathy (diabetes, tabes dorsalis, peripheral nerve injury) 8. Prior bone diseases (Paget’s, osteonecrosis) 9. Haemophilia 10. Congenital or developmental problems
244
Symptoms of osteoarthritis? (7)
Everything you’d expect from a joint that’s being worn down 1. Mostly affect the knee joint 2. Worse with activity 3. Stiffness after periods of non-use 4. Reduced range of motion (ROM) 5. Swelling of affected area 6. Crepitus 7. Joint line tenderness on palpation along the joint
245
Risk factors for getting osteoarthritis? (4)
1. Female sex 2. Old age 3. Obesity 4. Occupational activity (more use = more wear and tear)
246
What are Osteophytes?
Bony lumps (bone spurs) that grow on the bones of the spine or around the joints
247
Diagnostic criteria for Knee Osteoarthritis?
Knee pain + osteophytes, and any one of the following three: 1. Age \>50 2. Morning stiffness \<30min 3. Crepitus
248
Diagnostic criteria for Hip Osteoarthritis?
Hip pain and at least 2 of the following three: 1. ESR \<20 2. Steophytes in hip joint on X-ray 3. Joint space narrowing on X-ray
249
When should you suspect Rheumatoid Arthritis?
When you see the following: 1. Presence of synovitis in at least one joint 2. Absence of other diseases that explain the symptoms 3. Score of 6 or more on ACR/EULAR criteria
250
ACR/EULAR criteria parameters? (4+)
1. Amount of joints affected * 2-10 large joints (1 p) * 1-3 small joints (2 p) * 4-10 small joints (3 p) * \>10 joints with at least 1 small (5 p) 2. Presence of RF or ACPA * Low RF or ACPA (2 p) * High RF or ACPA (3 p) 3. High CRP or ESR (1 p) 4. Symptom duration \>6weeks (1p)
251
Demographic of RA
* Often start age 20-30, extra high risk age 30-50 * More common in females
252
Nons-specific systemic symptoms often found in RA? (5)
1. Fatigue 2. Malaise 3. Weight loss 4. Weakness 5. Low-grade fever
253
What's Ankylosing Spondylitis?
A condition of unknown etiology (but probably autoimmune/autoinflammatory), causing joint fusion, typically in the spine
254
Clinical symptoms of Ankylosing Spondylitis? (3)
1. Lower back pain and stiffness that improves with exercise, and is not relieved by rest 2. Limited motion of the lumbar spine 3. Limited chest expansion
255
Typical age of Ankylosing Spondylitis symptoms? More common in which sex?
People in their 20's, more commen men
256
Radiological findings of Ankylosing Spondylitis? (2)
1. Bamboo spine - spine seem stiff, there's fusion of vertebraes and the vertebraes seem a bit hollow 2. Sacroiliitis - inflammation of the sacro-ileal joint
257
What categogry of diseases does Ankyloding Spondylitis go under?
Spondyloarthropathies (Spondylo = Vertebrae and Arthropathy = joints)
258
2 divisions of spondyloarthropathies (SpA)?
1. Axial: Ankylosing spondylitis and non-radiographic spondyloarthropathy 2. Peripheral: IBD-associated SpA, reactive and psoriatic arthritis and undifferentiated SpA
259
Additional diseases/sumptoms that may accompany some SpAs? (5)
1. Heel pain (enthesitis) - RA 2. Uveitis (eye inflam) - AS and reactive arthritis 3. Dactylitis (sausage fingers) - psoriatic arthritis 4. Psoriasis - psoriatic arthrits 5. Crohn’s - peripheral arthritis/IBD associated SpA
260
Percentage of people that get lower back pain some point in their life?
80%
261
Serious causes for lower back pain, and percentage of LBP due to these?
\< 1% are due to the following 1. cancer 2. inflammatory diseases 3. fractures
262
Percentage of lower back pain patients that recover?
95% recover after 3 months
263
Most common cause of lower back pain in... * young people? * elderly?
* young people: Lumbar disc herniation * elderly: Osteoarthrites, comperession fractures and metastases
264
Most dangerous cause of lower back pain?
Caude Equina Syndrome: Disc herniation -\> compression of cauda equina -\> neurological problems in lower body THIS IS A SURGICAL EMERGENCY!
265
Symptoms of Cauda Equina Syndrome? (4)
Around the anus and genitals.... 1. Loss of anal and uretheral sphincter tone 2. Sexual dysfunction 3. Numbness in the saddle area 4. Loss of sensation when voiding
266
Smertetrapp?
* Step 1: * Paracet 1g x 3-4 * NSAID (Naproksen 250 - 500mg x 2) med PPI (Somac 40mg x 1) * Step 2: * Kodein (Paralgin eller Pinex Forte) 1-2tab x4 * Tramadol (maks.døgndose 150 - 400mg) fordelt på 3-4 doser * Step 3: * Morfin (tab, sc, iv, mikst, dråper) * Delcontin (langtids morfin) * Oxycontin depot (langtids) * Oxycodone eller Oxynorm (korttids) * Buprenorfin tab eller Norspan plaster * Targinic (buprenorfin + nalokson) * Ketobemidon Ketorax 1-3tab x 4-6 * Fentanyl depotplaster (last choice) \*kan også gi alternative medikamenter for spesifikke smerter
267
4 levels of disease prevention?
* Primordial - taking measures to stop patient being at risk of a disease (e.g stopping bad habits in childhood) * Primary - taking measures to stop at-risk patients from developing the disease (e.g sugar tax decrease obesity) * Secondary - taking measures to stop the disease at an early stage (e.g cancer screening) * Tertiary - taking measures to stop further progression of a disease (e.g preventing further complications)
268
Principles of Family Medicine patient care? (7)
1. **Patient focused** (concentrate on patient, not only the illness) 2. **Continuity** (the illness is just an episode in the doctor-patient relationship) 3. **Comprehensiveness** (includes all aspects of disease ‒ psychological, social etc...) 4. **Coordination** (identify patient needs to see a specialist, FM is fronltine) 5. **Preventive** (recognise risk factors, delay disease consequences, promote healthy lifestyle) 6. **Community oriented** (pay attention to things like occupation, culture, environmental/social habits) 7. **Family oriented** (understand the patient as part of a small social unit, how they are affected by it, and vice versa)
269
Disease vs Illness vs Sickness?
* Disease - an abnormal condition affecting an organism * Illness - bad feelings that might come with having a disease * Sickness - part of social identity
270
Timing of health checkups in children that can be of special consideration?
* 1st year * 1-2 week * 6-9 week: Vaccinations * 3rd-4th month: Vaccinations * 6th month * 9th month * 12th month * 2nd-3rd year: Vaccinations * 4th year * 5th year
271
Things that are often checked during health checkups in children? (5)
1. Physical development 2. Psychomotor 3. Behaviour 4. Vision/hearing/speech problems 5. Presence of testes in scrotum
272
Acute vs Chronic wounds?
* Acute wounds usually go through a normal healing process * Chronic wounds fail to heal properly, defined as \>3 months
273
3 ways of managing wound healing?
1. **Healing by first intention:** Wound edges are brought together and held in place with sutures, staples, strips etc. ‒ the dead space is eliminated, this gives minimal scarring. Typically easy with simple cuts 2. **Healing by second intention:** Granulation tissue fills in the dead space, and produces a larger scar than with 1st intention. Happens when there is a loss of tissue that makes closing the wound difficult 3. H**ealing by third intention:** Delayed primary closure. Wound is left open over a longer time for irrigation or removal of foreign materials, the wound can then be closed by first intention.
274
General management of acute wound?
1. Remove foreign materials, irrigate and clean with hydrogen peroxide, sterile saline, betadine etc... 2. Dry or wet dressing covers the wounds (depends on type of wound) 3. Suture if necessary \* Antibiotics are only necessary if there is evidence of local infection
275
Patient gets a wound and an abscess forms, what do you do?
Consider the size... * Large ones should be drained * Small ones can be treated with antibiotics.
276
Special step when treating a necrotic wound? Ways of doing that extra step? (5)
**Debridement**, many different ways: 1. Mechanical 2. Autolytic (moisture-retaining dressing for body's own enzymes) 3. Enzymatic (pharmaceutical enzymes added) 4. Biological (maggots) 5. Surgical
277
What is seen in sloughing wounds?
Yellowish patches are seen across the wound, these are fibrous tissue that cannot be washed off and needs to be removed for good healing
278
Burns: * 1st degree? * 2nd degree? * 3rd degree?
* 1st: Epidermis * 2nd (A): Superficial dermis * 2nd (B): Partial dermis (may cause scarring) * 3rd: Full depth, may have injured deeper structures. Not painful because the nerves are gone. Requires surgery
279
What's the Rule of 9's all about?
A rule used when dealing with burns. Body is divided into sections, each representing roughly 9% of total body surface area (TBSA)
280
How is the body devided according to the rule of 9's?
281
Hospitalization criteria for burns? (8)
1. 10% TBSA (5% if third-degree) 2. 5% in children 3. Burns to face, hands, feet, genitalia, perineum, major joints 4. Electrical or chemical burns 5. Inhalation injury 6. Circumferential burns or associated trauma 7. Suspicion of non-accidental injury 8. Very young or very old patients

6 MD (8 decks)

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