family medicine notes questions Flashcards
name the bedside test used to determine if bleeding is maternal or fetal?
modified APT test
name three medications used to treat early PPH
oxytocin
ergotamine
hemobate
what are risk factors for retained products of conception following birth?
-prior C-section
-uterine infection
-manual placental removal
-placenta previa
what are SE of SSRIs for the baby in a breastfeeding mom ?
irritability, insomnia
when does the risk of fetal death from parvovirus decrease?
at 20 weeks gestation
consequenses of parvovirus 19 infection in pregnancy?
fetal loss, hydrops/anemia, high output cardiac failure in baby
first line therapy for post natal depression
CBT
what are the two tests to diagnosis PROM?
-ferning
-nitrazine blue
risks associated with untreated BV in pregnancy?
-post partum endometritis
-preterm birht
-low birth weight
risk factors for BV
-pregnancy
-new sex partner
-multiple sex partners
-douching
-IUD use
causes of pediatric vaginitis?
-non specific (irritants, tight clothing, thin mucosa)
-bacteria (e coli, H influenza)
-rarely candida
-foreign body
-systemic illness (chickenpox)
-poor hygeine
-pinworms
-sexual abuse/STI
-dermatologic (eczema, psoriasis, lichen sclerosis)
name 3 indications for hip US for ddhx?
-breech
-family hx
-abnormal exam finding
when do the posterior and anterior fontanelles close?
2 mo
18 mo
how do you switch from the patch to the OCP?
take the first pill one day before taking off the patch
how long can the nuva ring be outside of the vagina for ?
3 hours
name three shockable rhythms
VF
pVT
torsades de pointes
most common site for lung cancer metastasis?
liver
what do you advise pts to do during a hypoglycemic episode?
-take 15g glucose
-retest BG in 15 minutes
-repeat glucose load if it remains < 4
if both IFG and A1C are between 6 - 6.4, what is the risk of progression to T2M in 5 years?
100%
what are the criteria for screening for DM in adolescents/children:
PREPUBERTAL if 3/4 and PUBERTAL if 2/4 of:
-obesity
-s/s of insulin resistance such as acanthosis nigracans, NAFLD, hyperlipidemia
-1st degree relative with DM or utero exposure
-increased risk ethnic group
Which patients with prediabetes should consider metformin?
Age <60
Hx of GDM
BMI > 35
what factors may increase an A1C (impair accuaracy)
-iron deficiency, B12 deficiency, alcoholism, CKD, chronic opioid use
what factors may decrease an A1C (impair accuracy)
–iron/B23/vitC/E supplementation, asa use, hemoglobinopathy, chronic liver dz, CRF, RA, antiretrovirals , splenomegaly
what DM medication should be avoided/cautioned with a history of severe alcohol abuse?
SGLT2i
what is the A1C cutoff for diabetes?
≥6.5%
what is the fasting blood glucose cutoff for diabetes?
≥7 mmol/L
angina criteria (3)
-substernal chest discomfort: dull/ache/heaviness, that might or might not radiate to jaw, neck, shoulders or arms
-provoked by exertion or stressed
-relieved within 5 minutes by rest or nitroglycerin use
exam findings consistent with ischemic heart disease
-Hypotension
-new S3 gallop
-new JVP distention
-pulmonary rales
-mitral regurgitation
if someone is having an MI and there allergic to NSAIDS, do you give aspirin?
NO
ECG findings suggestive of STEMI (list 2)
-new LBBB
-ST elevations - 2 contiguous leads of >0.1mV (>0.2mV in V2 V3
what does a new Q wave suggest?
STEMI or NSTEMI
name 5+ causes of elevated troponin?
HF, malignancy, pericarditis, sepsis, stroke, SAH, PE, myocarditis
if someone is having an MI and can’t take aspirin what do you give them?
300 mg clopidegrel then 75mg OD
which patients with hx ACS should be prescribed an ACEi?
STEMI in anterior location, DM, HTN, CKD, LVEF <40%
(but can consider in all patients who have had cardiac/vascular disease)
A patient is having an NSTEMI. What are the indications for immediate invasive strategy?
-unstable vitals
-refractory angina
-HF
-sustained VT/VF
what are the absolute contraindications for fibrinolysis?
intracranial hemorhage, cerebral lesion/malignancy, head/facial trauma < 3 mo, ischemic stroke <3 mo, active bleeding, aortic dissection, severe uncontrolled HTN
within how many minutes should PCI be performed?
90
within how many minutes should fibrinolysis be performed?
30
what is the most common SECONDARY cause of HTN?
chronic renal insufficiency
in which age group should beta blockers be avoided as a first line HTN management?
≥60
what populations should beta blockers be avoided for management of HTN?
-raynauds, asthma, ≥60, heart block or sick sinus syndrome, severe PAD, uncompensated HF
if someone has angioedema on an ACEi, what is the chance they have it with ARBs?
10% cross reactivity
Management of pulmonary edema secondary to HTN emergency?
IV enalapril, nitroinfusion, sublingual captopril
Management of ACEi angioedema?
-stop offending medication
-possible intubation / respiratory support
-epinephrine
-steroids/antihistamine for mild cases
-consider icatibant (bradykinin antagonist), FFP
name 5 peices of advise for taking home blood pressure readings?
-appropriate cuff size (40% circumferance of arm and 80-100% length)
-measure in non dominant arm unless >10 mmhg difference
-relax for 5 minutes with back straight and feet on floor
-no coffee or smoking for 1 hr prior
-no exercise for 30 minutes prior
-take 2 before breakfast and 2 after dinner
-average day 2-7
patients with afib over what AGE get OAC regardless of other factors?
65+
what is considered a low reccurrence rate of paroxysmal afib?
1-2 episodes per year
if someone has high reccurrence of paroxysmal afib what is the management of choice?
rhythm control (ablation or cardioversion)
if someone who has afib is on rate control and remains symptomatic, what is the next step?
rhyhtm control (cardioversion)
During what time period of afib does rhythm control improve mortality?
first 12 mo
management of ED patient with unstable afib?
-immediate rate control
-immediate OAC then cardioversion
how long should someone be anticoagulated (minimum) for after cardioversion?
4 weeks
if afib started within ___ hours and the patient has a CHADS of ____ then cardioversion
48 hours, 0-1
If a patient in afib has had symptoms less then 12 hours, but has a hx of ___ within the last 6 months, then NO cardioversion
CVA
what type of afib requires anticoagulation with warfaran?
valvular
what factor increases bleeding risk on anticoagulation?
<60kg
what is the name of the sign for DVT that has pain with dorsiflexion of ankle?
Homans sign
