Family Medicine Clerkship - Brainscape Flash Cards - Cases 1-5
Case & Q
Answer
Case 1: General approach to a health maintenance exam?
1) immunize; 2) cancer screen; 3) CVD screen & prevention; 4) depression/EtOH/tobac/substance screen; 5) lifestyle counseling for: exercise, diet, safe sex and seat belt/DUI
Case 1: Age to start lipid screening?
men >35; women >45; those at risk >22
Case 1: who should get aaa screening?
men 65-75 y/o who have ever smoked
Case 1: When should you screen asx pts for DM?
when pt has h/o HTN or hyperlipidemia
Case 1: Age to start recommending colon CA screening?
50
Case 1: basic screening for CVD
1) lipids at appropriate ages (>35 for men, >45 for women, >20 for those at risk); 2) BP checks; 3) screen for obesity; 4) AAA screen if male 65-75 who has ever smoked
Case 1: Vaccines to verify/offer at adult preventive health visit?
Tdap (q10 yrs or 2yrs after last Td for aP protection); flu (qYr); varicella if never vaccinated/infected; HepA, if indicated; HepB, if indicated; pneumococcal, if indicated; meningococcal, if indicated
Case 1: Indications for Hep A vaccination?
IVDU, MSM, chronic liver dz, pts using blood products (esp. clotting factors), occupational risk, travel
Case 1: Indications for Hep B vaccination?
IVDU, MSM, chronic liver dz, pts using blood products (esp. clotting factors), occupational risk, dialysis pts, persons w/ multiple sex partners, recent h/o STD
Case 1: Indications for pneumococcal vaccination?
all adults 65+; also those with: immunodeficiency (esp asplenia) smokers; EtOHic; and pts w/ chronic dz (incl. DM, CV, pulm (incl asthma), renal or hepatic dzs)
Case 1: Indications for meningococcal vaccination?
crowded housing (dorm, military), complement deficiencies, asplenia, travel
Case 2: FEV1:FVC ratio in COPD pts
< 0.7 (nl > 0.7)
Case 2: Role of smoking cessation in COPD pt care?
slows decline but does not improve sx
Case 2: Staging of COPD
Stage 0 (“At risk”) - cough, sputum production w/ nl spiro; Stage I (Mild) - FEV1/FVC 80% of predicted +/- sx; Stage II (Moderate) - FEV1/FVC <30% of pred.
Case 2: Mgmt of Mild COPD (Stage I)
Short-acting bronchodilators PRN (e.g. albuterol and ipratropium)
Case 3: rod-shaped, rhomboid, weakly positive birefringence
pseduogout crystals (calcium pyrophosphate dehydrate)
Case 3: needle-like, strongly negative birefringence
gout crystals (monosodium urate)
Case 3: bipyramidal appearance of crystals w/ strongly positive birefringence; common in ESRD pts
calcium oxalate crystal-induced arthritis
Case 3: non-birefringent cytoplasmic inclusions seen on EM
calcium hydroxyapatite crystal-induced arthritis
Case 3: class of common meds that causes hyperuricemia
thiazides
Case 3: WBC from joint aspirate of crystal-induced arthritis VS. septic joint
crystal-induced: 2k-60k w/ < 90% PMNs; septic: avg 100k (range 25k-250k) w/ > 90% PMNs
Case 3: gouty attack of the 1st metatarsophalangeal joint
podagra
Case 3: categories for ACR/EULAR R.A. dx criteria
1) synovitis in 1+ joint(s); 2) all other dx ruled out; 3) # & size of joints involved; 4) RF +/- anti-CCP serology; 5) acute-phase reactants; 6) sx duration 6+ weeks
Case 4: when is u/s indicated in prenatal care?
not mandatory in low-risk cases; indicated for: 1) uncertain gest age, 2) size/date discrepancies, 3) vaginal bleeding, 4) multiples and 5) other high-risk situations
Case 4: labs for initial prenatal visit?
CBC, HBsAg, HIV, RPR, UA & culture, rubella Ab, blood type/Rh, Pap smear, and swab for GC & chalmydia
Case 4: risk to pregnancy from dental x-rays?
no known risk; exposure must be > 5 rad (dental xray is 0.00017 rad; chest and extremity are well below 5, too)
Case 4: when is optimal time to screen expectant mothers w/ the trisomy screen test
Either: 1st tri w/ nuchal translucency on u/s +/- serum hCG & PAPP-A, OR 2nd tri w/ triple screen (AFP, hCG, estriol) or quadruple (above + inhibin-A); Newer research says do all of the above
Case 4: asymptomatic bacteriuria
> 100,000 cfu/mL of a pure pathogen from mid-stram clean catch; TX INDICATED IN ALL PREG WOMEN
Case 4: folic acid recommendations for pregnant women
start 1+ month before conception if possible; low-risk moms: 400-800 ug QD; higher-risk (DM or epilepsey) 1 mg QD; h/o of prior child w/ NTD: 4 mg QD
Case 4: Naegle’s rule
EDD = first day of LMP - 3 months + 7 days
Case 4: LMP is considered reliable if?
a) date is certain, b) LMP was normal c) no contraceptive use in past year, d) no bleeding since LMP, e) menses are regular; IF NOT, then order U/S
Case 4: you should be able to hear fetal heart tones by ___ weeks w/ a fetoscope
00010
Case 4: how often should you schedule post-natal f/u visits?
q4 wks ‘til 28 wks THEN q2 wks 28-36 wks THEN qWk ‘til delivery
Case 4: ROS for prenatal f/u visits? What are you screening for?
bleeding? Fluid loss? h/a? visual ∆s? abdominal pain? Dysuria? Facial or UE edema? Vag discharge? Subjective sensation of fetal mov’ts? LOOKING FOR: gest HTN, preeclampsia, infections, fetal compromise, placenta previa/abruptio, and preterm labor/premature rupture of membranes
Case 4: P.E. for prenatal f/u visits?
weight, BP, fundal ht, fetal heart tones, and UA for prot/gluc/infx
Case 4: which ob pts should be offered amnio or CVS?
pts at increased risk for aneuploidy (>35 w/ singletons, >32 w/ twins, major structural anomaly of uterus, etc.)
Case 4: when to screen for gest DM? preferred method? Interpretation?
at 24-28 wks; 50g glucose 1hr challenge; should be < 135; if 135-200 do 3hr, if > 200 dx = gest DM
Case 4: 28 wk visit
repeat RPR, get H/H (anemia screen), give RhoGAM if Rh-
Case 4: when to screen for GBS?
35-37 weeks vaginorectal screening (lower vagina, perineum and rectum)
Case 4: when to consider induction?
42 weeks
Case 4: vaccinations in pregnant women?
flu & tetanus OK; varicella, rubella and live intranasal flu are not (vacc rubella in mom after deliv)
Case 5: dev milestones for 1 mo
MOTOR: reacts to pain; LANG: responds to noise; SOCIAL: regards human face, eye contact
Case 5: dev milestones for 2 mo
MOTOR: eyes follow object to midline, lifts head to prone; LANG: vocalizes; SOCIAL: social smile, recog parent
Case 5: dev milestones for 4 mo
MOTOR: eyes follow obj past midline, rolls over; LANG: laugh, squeal; SOCIAL: regards hand
Case 5: dev milestones for 6 mo
“Six strangers switch sitting” MOTOR: sits up, pass obj between hands, rolls prone->supine; LANG: babbles; SOCIAL: reco strangers
Case 5: dev milestones for 9 mo
“It takes 9 mos to be a “mama”; “Can crawl therefore explore” MOTOR: crawls, cruises (pulls to stand & walks), pincer grasp @ 10mos; LANG: mama, dada, bye-bye; SOCIAL: explore
Case 5: dev milestones for 12 mos
“WALKING away from mom causes ANXIETY” “1 word by 1 yr” MOTOR: walks, throws; LANG: 1-3 words, follow 1 step command; SOCIAL: stranger & separation anx
Case 5: dev milestones for 2 yrs
“puts 2 words 2gether @ 2” “ 2/4 words understood by strangers” MOTOR: walks up and down stairs, copies a line, runs, kicks ball; LANG: 2-3 word phrases, 1/2 speech understood, refers to self by name, pronouns; SOCIAL: parallel play
Case 5: dev milestones for 3 yrs
“tricycle, 3 cubes, 3 colors, 3 kids make a group” “at age 3, 3/4 words understood by strangers MOTOR: copies circle, pedals a tricycle, build a bridge of 3 cubes, repeats 3 numbers; LANG: sentences, 3 colors, 3/4 words understood
Case 5: dev milestones for 4 yrs
“four parts of song head, shoulders, knees and toes = 4 y/o knows body parts” “at age 4 4/4 words understood by strangers” “2 lines to draw a cross and square, both w/ 4 sides” MOTOR: ID’s body parts, copies a cross, copies a square (4.5 y/o), hops on one foot, throws overhand; LANG: speech 100% compr, uses past tense, tells stories; SOCIAL: plays w/ kids, social interactions
Case 5: dev milestones for 5 yrs
MOTOR: copies a triangle, catches a ball, partially dresses self; LANG: writes name, counts 10 objects
Case 5: dev milestones for 6 yrs
MOTOR: draws a person w/ 6 parts, ties shoes, skips w/ alternating feet; LANG: ID’s L & R
Case 5: lead screening in WCCs?
Check levels at 12 mos & 2yrs if exposure (think houses > 1950 or > 1972 if renovation, other sib tx’d, parent who hobby or occupational expos, pottery, treated wood)
Case 5: anemia screening in WCCs?
9 mos
Case 5: hearing screening in WCCs?
state mandated at birth, esp hi-risk (FmHx of childhood hearing loss, craniofacial defects, syndromes w/ hearing loss like NF, IDs like bact meningitis)
Case 5: vision screening in WCCs?
red reflex at birth, subjective by parents, also remember recog face by 1 mo and consistent and symmetric mov’t by 6 mos (eval w/ comparison of relections), cover/uncover test for strabismus, Snellen chart after 3 year (w/ pictures)
Case 5: lipid screening in in WCCs?
between 2-10 y/o if: FMHx of dyslip OR FMHx of premature CND or dyslipidemia (men 95th %ile, BMI > 85th %ile, DM or smoking); if nl, repeat in 3-5 years
Case 5: TB screening in WCCs?
should be done in kids living in high-risk areas or who have contact; use PPD
Case 5: rear-facing car seat ‘til when?
1 year old AND >20 lbs
Case 5: booster seat?
> 40 lbs (between 20-40 lbs, forward-facing car seat)
Case 5: when to d/c booster seat?
when child can sit w/ back squarely against back of seat and have legs at 90° dangling over seat edge
Case 5: front seat is okay when?
13 y/o no sooner
Case 5: breast-feed or formula only until when?
6 mos, ideally breast-feed 1 year
Case 5: Is a minor illness w/ low-grade fever a contraindication for immunization?
NO! Sick visits are a great chance to double-check that shots are up-to-date
Case 5: immunizations at birth?
HepB#1
Case 5: immunizations at 2 mo?
HepB#2, RV#1, DTaP#1, Hib#1, PCV#1, IPV#1
Case 5: immunizations at 4 mo?
RV#2, DTaP#2, Hib#2, PCV#2, IPV#2
Case 5: immunizations at 6 mo?
HepB#3 (or thru 18 mos), RV#3, DTaP#3, Hib#3, PCV#3, IPV#3; START FLU
Case 5: immunizations at 12 mo?
HepB#3 (6-18mos), Hib#4, PCV#4, IPV#4, MMR#1, Varicella#1, HepA 2 doses
