1
Q
T/F: Since the introduction of screening in the USA, incidence of CRC has decreased while incidence of breast and prostate CA have increased
A
true
2
Q
Begin discussion on bicycle helmets at what visit?
A
*Begin discussion on bicycle helmets at the 2 year visit
Sooner if a passenger of a parent on a bicycle
3
Q
Children exposed to tobacco smoke are at increased risk for what 3 things?
A
asthma
SIDS
URIs
4
Q
-graphical representation of the family history
A
pedigree
5
Q
what type of prevention:
provided to individuals who clearly have a disease, and the goal is to prevent them from developing further complications.
A
Tertiary Prevention
6
Q
11 geriatric syndrome
A
- Cognitive impairment
- Delirium
- Incontinence
- Malnutrition
- Falls
- Gait disorders
- Pressure ulcers
- Sleep disorders
- Sensory deficits
- Fatigue
- Dizziness
7
Q
refers to a single gene (few genes)
A
genetics
8
Q
4 multi modal approaches to treating CRPS
A
- psychological
- pharmacological
- physiotherapy
- interventional procedures
9
Q
peak performance occurs at waht age?
-loss of reproductive ability what age?
A
pp: 20-30
loss of reproductive: 45-55
10
Q
__% of teens have sent a sexting message
-emotional and legal impacts
A
20%
Considered a criminal offense –> leads to suspension, permanent record, police involvement
11
Q
begin asking at the __ year WCC about conflict and bullying
*__% of children are either bullied or a bully
A
11 yr
30%
12
Q
Older individuals are at greater risk for adverse drug events due to:
A
metabolic changes and decreased drug clearance associated with aging
13
Q
Adults surviving into late life suffer from high rates of chronic illness; ___% have at least one and ___% have at least two chronic conditions
A
80% have 1 chronic illness
50% have at least 2 chronic illnesses
14
Q
what happens to esophageal skeletal muscle w/ age?
A
atrophies at upper third of esophagus–> swallowing problesm–> risk for aspiration
15
Q
recommendations for prostate CA screening
A
- reasonable in healthy men 55-69 y/o
- men over 75 should NOT be screened
- PSA or FOBT
16
Q
sx: Headaches (severe, recurrent) often worse in AM or supine Papilledema, peripheral vision loss possible
A
Psuedotumor Cerebri
17
Q
5 Indications for genetic counseling and/or testing (clues to genetic disorders)
A
- ‘Known’ Genetic Disorder
- Positive Family History
- Premature presentation
- Unusual presentation
- Unexpected natural progression
18
Q
sx:
pelvic obliquity
weak core strength
myofascial tenderness, muscle spasm
A
sacroillitis (sciatica)
19
Q
4 pillars of health for geriatric population
A
- diet
- exercise
- sleep
- attitude
20
Q
sx: acanthosis nigrican
A
-impaired glucose metabolism
21
Q
how should firearms be stored?
A
- The gun should be locked away
- Ammunition should be locked away separate from the gun
22
Q
- Anesthetic medication and a steroid are injected into the epidural space around a disk under fluoroscopic guidance
- Controversial due to little evidence of long term pain relief
- Effective for patients who are not surgical candidates
A
transforaminal epidural steroid injection
*used for back pain tx
23
Q
GI comorbidities associated w/ childhood obesity
A
- non-alcoholic fatty liver disease
- gallstones
- constipation/encopresis
24
Q
Geriatric patients should be screened for colon cancer until age __
A
75
25
saddle anethesia and loss of bowel/bladder control are assoicated w/ what dermatomes
- Saddle Anesthesia(S3-S5)
| - Loss of Bowel/Bladder control (S2-S4)
26
normal changes that occur with age in various systems including: Cardiovascular, Pulmonary, Renal, Gastrointestinal, Musculoskeletal
programmed aging
*genetics and environmental factors also play a role
27
a term that is commonly applied to mild or moderate protein energy malnutrition in this country
failure to thrive
28
endocrine comorbidities of obesity in children
- impaired glucose metabolism
- DM2
- PCOS
- hypothyroidism
29
Colorado Law:
Rear-Facing Car Seat
Up to ____ AND ___
AAP recommends what?
Rear-Facing Car Seat
Up to age 1 AND 20 lbs
-AAP now recommends Rear-Facing Car Seats until 2 years of age or until they reach the height/weight requirement of their car seat
30
An apparent loss of physiologic reserves in older adults leads to intolerance to challenges to their homeostasis
-the older person is continually expending reserves to compensate for primary age changes
homeostenosis
31
Compression of multiple nerve roots below the Conus Medullaris (L1-2)
Numbness and tingling in groin
cauda equina syndrome
32
____: the proportion of people without the target disorder who have a negative test result
Specificity: the proportion of people without the target disorder who have a negative test result
33
SUN SAFETY
- limit sun exposure between____
- use sunscreen of at least SPF __ and reapply ___
- sunglasses should block what rays
- wear wide brimmed hat __ inches or has ___
- limit sun exposure between 10am-4pm
- use sunscreen of at least SPF 15 and reapply every 2 hrs or after swimming
- sunglasses should block UVA and UVB rays
- wear wide brimmed hat 3 inches or has bill
34
do these supplements have evidence to help with weight loss
- Tiratricol
- 5-HTP
- 7-Keto-DHEA
- Bean pod
- Caralluma
- Chitosan
- Chromium
- Green tea
- Guarana
- Guggul
- Licorice
- Magnolia
- Rose hip
- Willowbark
ineffective/insufficient evidence
35
how much exercise is need to:
prevent weight gain:
maintain weight loss:
prevent weight gain: 150-200min/wk moderate intensity
maintain weight loss: 200-300+ min/wk moderate intensity
36
how many pairs of chromosomes and how many genes in humans
23 paris of chromosomes
~22,000 genes
37
Beginning talking about drugs, alcohol and tobacco at the __ year WCC
Beginning talking about drugs, alcohol and tobacco at the 9 year WCC
38
(very severe FTT): body weight under 60% median (50th %ile) for age
Marasmus
39
T/F: early detection of CA improves survival even if death isn't delayed by early screening?
true
40
__ has a strong association w/ dependency in activities of daily living
geriatric syndromes
41
Room-Sharing = __
vs
Bed sharing = ___
Room-Sharing = OK
Article: May decrease SIDS as much as 50%
Bed-Sharing = NOT OK
Including In-Bed Co-Sleepers
42
Keep child in booster seat until ____ tall
Keep child in booster seat until 4’9” (57”) tall (MAY be after the child is 8)
- Shoulder belt should cross at the chest and shoulder (Not at the neck)
- Lap belt should cross at the upper thighs (Not at the abdomen)
- Knees should bend at the edge of the seat and feet should dangle down
43
goal of geriatric care
- promote wellness and independence,
| * Decline in function and loss of independence are NOT an inevitable consequence of aging
44
genetic testing can help with what>
1. diagnosis
2. management strategies
3. targeted treatment
4. high-capacity DNA analysis
45
what Grade?
| -clinicians may provide this service to selected patients depending on individual circumstances
Grade C
46
how much exercise is need to contribute to weight loss for:
- Health benefits and minimal to no weight loss-
- moderate weight loss-
- larger weight loss
- Health benefits and minimal to no weight loss- less than 150min/wk mod. intensity
- moderate weight loss- 150-225min/wk mod. intensity
- larger weight loss- 200-300+ min/wk of mod. intensity
47
what should the first action be if a child ingests a poison?
call poison control!
*do not use syrup of ipecac or charcoal as interventions
48
what PE do u do when someone presents w/ pain neck pain w/ flexion/extension-discogenic
Spurlings test
| Looking for radicular sx
49
For breast-fed infants, need source of iron and zinc after what age
6 months
50
Restraint system allows for what 4 things?
1. ejection risk to decrease
2. distributes the energy load of the crash through bones rather than soft tissues (bones are stronger)
3. limits the crash forces by prolonging the deceleration
4. limits the contact with the vehicle and other occupants.
51
___ is the 3rd leading cause of death with ___ as the most common method used
firearms
*85% of all homicides were firearms-related
52
how many people over 80 have a neurological disorder (ie. alzheimers or parkinsonism)
1/3rd
53
sx: Oligomenorrhea (
PCOS
54
what Grade?
-certainty that the net benefit is moderate to substantial USPSTF recommends the service, there is a high certainty that the net benefit is moderate or there is moderate
Grade B
55
____: performed to determine the presence or absence of a specific disease or condition in symptomatic individuals.
Diagnosis: performed to determine the presence or absence of a specific disease or condition in symptomatic individuals.
56
6 Cardiovascular changes w/ aging?
- procoagulant---> risk of DVT
- increase CAD and HTN age
- heart valves thicken and calcify
- heart muscle thickens
- arteries harden and veins lose tone (edema)
- conduction is impaired (murmurs and afib)
57
advance care preferences for patients
- MDPOA (MOST Important!!)
- Colorado MOST form (CPR directive)
- 5 wishes
- Living will
58
- Chance an average risk 50 year old will be diagnosed with CRC in their lifetime?
- Chance an average risk 50 year old will die of CRC in their lifetime?
- Chance an average risk 50 year old will be diagnosed with CRC in their lifetime? (5%)
- Chance an average risk 50 year old will die of CRC in their lifetime? (2%)
59
-Children younger than ____ travel nearly as much as adults in a vehicle
~__ trips/day, ___ minutes/day
Children younger that 16 years travel nearly as much as adults in a vehicle
~3.4 trips/day, 45-50 minutes/day
60
3 rules of thumb to help patients w/ screening decisions
1. be skeptical
2. know your risk and benefits (absolue risk)
3. patients are experts too and have preferences
61
red flags for back pain
- CA
- Compression fracture
- corticosteroid use
- Infection
- duration greater 1month w/ no improvement w/ rest
62
when does weight typically drop off then rebound for children
drops off around age 2-4 y/o
| -starts rebounding by 5
63
main proteins found in human milk and cow milk
human-whey
| cow-casein
64
-Parents tend to ____ the child’s cognitive and sensory skills (how fast a car is coming)
Parents tend to _____ the child’s motor skills (ability to climb)
Parents tend to overestimate the child’s cognitive and sensory skills (how fast a car is coming)
Parents tend to underestimate the child’s motor skills (ability to climb)
65
___ is the final common pathway in nonorganic FTT and in most cases of organic FTT.
Failure to thrive
66
-Chance an average risk 50 year old man will be diagnosed with prostate cancer in his lifetime?
Chance an average risk 50 year old man will die of prostate cancer in his lifetime?
- Chance an average risk 50 year old man will be diagnosed with prostate cancer in his lifetime? (20%)
- Chance an average risk 50 year old man will die of prostate cancer in his lifetime? (3%)
67
key diet factors associated w/ childhood obesity
1. Sweetened Beverages and Juice
2. Fruit and Vegetable intake
- fiber, low energy density
3. Energy Dense foods
- processed
4. Restaurant Meals
- Not just fast food, vs. Family Meals at home
5. Large Portion Sizes
- Especially poorly satiating starches
6. Frequency of eating:
- Schedule for meals/snacks ~q3hrs, breakfast qAM
68
Pet saftey recommendations
- wait to get a dog until child is 4yr or older
- don't pet when eating or sleeping
- treat dog bites immediately
69
polypharmacy in geriatrics leads to what 4 things
- Prescribing errors
- Cost
- Incidence of adverse drug reactions and drug‐drug interactions
- Prescribing cascades
70
3 things for facet pain back pain
- facet joint injection
- medial branch block
- radiofrequency neurotomy
71
w/ acute back pain, ___% of time no specific source is found
80%
72
more than __% of deaths from flu are ppl over 65
90%
73
- Chance an average risk 50 year old woman will be diagnosed with invasive breast cancer in her lifetime?
- Chance an average risk 50 year old woman will die of breast cancer in her lifetime?
Chance an average risk 50 year old woman will be diagnosed with invasive breast cancer in her lifetime? (10%)
- Chance an average risk 50 year old woman will die of breast cancer in her lifetime? (3%)
* Mammography not decreasing late disease but mortality IS decreasing (b/c of treatment)
74
what PE do you do w/ someone w/ pain w/ flexion and extension- discongenic
Straight leg raise
75
__% of children find unwanted pornography on the internet
~__% of US children have been cyber-bullied
25% of children find unwanted pornography on the internet
~6% of US children have been cyber-bullied
76
___: ability to measure the actual value of the quantity being measured
Accuracy: ability to measure the actual value of the quantity being measured
77
when communicating w/ families about childs weight, discuss __ with parents and discus __ with child
w/ adult: AVOIDABLE health riks
w/ child: quality of life issues (sports, energy, confidence, clothing)
78
It is estimated that 1 in __ girls and 1 in __ boys are affected by child sexual abuse
It is estimated that 1 in 4 girls and 1 in 7 boys are affected by child sexual abuse
*40% are under the age of 6
79
what is the best diet for weight loss?
calories in less than calories out
* no magic diet
* adherence is key!
80
If the prevalence of a disease is low, is a positive result more likely to be a “real” positive or a “false positive?”
?
81
70% of obese children had 2 or more or waht
```
low HDL
high LDL
HTN
insulin resistance
84% remained obeses at age 27
```
82
Approximately __ of community-dwelling persons age 65 years have a fall risk and ___ of those over 80 years of age fall each year
1/3rd
1/2
*hip fractures are life-changing
83
what 5 factors promote obestiy in adults
- Food
- Inactivity
- drugs
- environment (lack of sleep,time, food)
- individual (genetics, fhx, knowledge)
84
6 problems with popular diets
- too much of one nutrient and too little of other nutrients
- Restrict liquids
- Unrealistic weight loss promises
- Expensive
- Little variety and boring
- Adherence is difficult
85
recommendations for colon CA screening
- good idea for 50-75y/o
- avoid after 85y/o
*best test is the one that gets done--> decreases you chance of getting and dying from colon CA
86
4 methods of pain control for back pain
- myofascial release
- interferential stimulation
- phonophoresis
- dry needling (myofascial tenderness, muscle spasms)
87
```
sx: snoring most nights, apnea, poor sleep,
nocturnal enuresis,
AM headaches, fatigue,
poor school
performance
```
obstructive sleep apnea
13-33% of obese youth
88
5 S's to calm a baby
```
Swaddle
Swing
Shush
Suck
Side/Stomach position
```
89
Fx risk factors for childhood obesity
- obesity
- CVD (early MI, DM2, HTN, HLD,
- hypothyroidism
- psychiatric issues (eating disorders)
90
Diabetes mellitus – AGS recommends Hgb A1c ___% in healthy geriatric adults, 8‐9% in patients with multiple morbidities and lower life expectancy
7-7.1%
91
weight management strategies
surgery
pharmacotherapy
lifestyle modification (diet and exercise)
92
what type of prevention:
screening to identify risk factors for disease or the early detection of a disease among asymptomatic and at-risk individuals.
Secondary Prevention
93
what is considered the "good" fat and "healthy" fat
```
monounsaturated fat (MUFA)
*in olive oils, nuts, avocados, canola oil, seeds
```
polyunsaturated fats (PUFA)
94
psychiatric comorbidities associated w/ childhood obesity
- depression/anxiety
| - eating disorder
95
the national weight control registry showed these4 things are associated w/ ppl who maintained their weight loss
- eat breakfast
- weigh themselves 1x per week
- was less than 10hr of TV per week
- exercise on avg 1 hr per day
96
over the counter weight loss supplements are most commonly used by
```
women
minorities
25-34 y/o
college educated
obese/overweight
```
97
If teenager is in the front seat what should you do?
If teenager is in the front seat, move chair back as far as it can go
98
USPSFT recommendations for who needs to lose weight:
AHA/ACC/TOC recommendations for who needs to lose weight:
USPST: BMI of 30+, possible waist circumference
AHA/ACC/TOC: BMI 30+ or BMI 25+ w/ 1 or more risk factor (waist circum, traditional risk factors)
99
T/F: RCT's demonstrate the superiority of screening colonoscopy over FOBT for reducing CRC mortality
False
100
normal breastfeeding pattern
- Very frequent initially (q 1-2 hr); gradually extends to q 3-4
- Newborn - max interval 5 hr
101
strategies to help treat childhood obesity
- involve family
- make plan to monitor change (increase awareness and accountability)
- positive feedback/rewards
- Motivational interviewing
* *Know CORE VALUES!!
102
depression is higher in what geriatric populations
```
hospitalized
strokes
MI
CA
nursing homes (over 50%)
```
103
Ideal intervention for weight management in adults:
- ____ face-to-face counseling sessions with a trained interventionist in the first 6 months of treatment
- Produce 1 year average ___% weight loss
14 or more
8%
104
what happens w/ bone marrow mass and bone marrow fat w/ age
bone marrow mass- decreases
bone marrow fat- increases
*more sensitive to CA treatments
105
in men, screen lipid panel for men 35 then until what age?
65
106
what medications should be avoided in geriatrics?
Beer's list criteria
ex. Diphenhydramin, NSAIDs, TCAs, benzodiazepines, amiodarone, antipsychotics, ambien, bladder anticholinergics
107
how much of your plate should be fruits veggies
1/2 plate- fruits and veggies
108
what BMIs define underweight, health weight, overweight, and obesity in adults?
- Underweight BMI less than 18.5
- Healthy weight BMI=18.5-24.9
- Overweight BMI=25.0-29.9
- Obesity BMI over 30.0
109
Tobacco smoke can be measured up to ___away
Tobacco smoke can be measured up to 20 feet away
110
90% of back pain problems occur at the ____ and ____ disks
L4-5 and L5-S1 disks
111
4 popular weight loss supplements
Herbal CNS stimulants
Herbal diuretics
Herbal stimulant laxatives
Herbal appetite suppressors, fat and starch blockers
112
reflexes assocaited dermatomes to check for back pain
reflexes:
patellar reflex--L4
Achilles reflex- S1
113
what dermatomes / tests do you check w/ neck pain
Thumb/Index finger -C6
Middle finger- C7
Ring and Pinkie -C8
*spurling test and symptoms
114
Sustained weight loss of ___% produces clinical meaningful health benefits and greater loss produces greater benefit for adults
3-5%
115
edematous malnutrition with body weight 60 - 80% median for age; typically associated with hypoalbuminemia
Kwashiorkor
116
transforaminal epidural steroid injection is used for waht type of back pain
- Discogenic pain
| - Radiculopathy
117
how do you test for peripheral nerve entrapment of the median nerve?
Phalen’s Test
| Tinel’s Test
118
screen smoking men for AAA btwn what ages
65-75
119
what Grade?
-the USPSTF has concluded that there is at least moderate certainty the harms of doing
the intervention equal or outweigh the benefits in the target population
Grade D
120
derm. comorbidities associated w/ childhood obesity
acanthosis nigrican
intertrigo//furunculosis/panniculitis
hydradenitis suppurative
121
describe a good sleep environment for a baby
1. firm mattress
2. fitted sheet ONLY (no pillows, comforters, or bumper pads)
3. No drop-down crib rails--> entrapment and suffocation
4. no adult bed--> entrapment and suffocation
5. away from cords (strangulation)
6. consider pacifier
*Car seats, strollers, swings, carriers, slings --> NOT recommended for routine sleep
122
___is the best predictor of weight loss maintenance
physical activity
123
when do you consider an MRI for back pain
- listhesis is present on xray
- evaluate soft tissue, disks, nerves, facet joints
- red flags present
- Radiculopathy with acute neurological findings
124
higher prevalence groups of obesity in children
- older children and adolescents
- NA, black, latino
- low socioeconmic status
* maternal education is most imporatnt SES predictor of childhood obesity worldwide
125
what should you try to calm a baby?
check for hunger, wet diaper, fever, burp
126
describe the 2 types of CRPS
Type I: No evidence of nerve injury
-Hand surgery
Type II: Evidence of nerve injury
-Obvious injury to limb
127
- "obese" correlates with what percentiles
- "overweight" correlates with what percentiles
- "underweight" correlates with what percentiles
- "Severely overweight" correlates with what percentiles
obese: over 95th%tile
overweight: 85-95th%tile
underweight: less than 5th%tile
severely overweight: over 99th%tile / over BMI 35**Comorbidities (4% of population)
128
Depressive illness in the older population is a common and serious health concern that is associated with:
comorbidity,
impaired functioning,
excessive use of health care resources,
increased mortality (including suicide, double that of the general population)
129
sx: cold intolerance, decline in
school performance, coarse
features, thin hair
-poor linear growth
hypothyroidism
130
child obesity is greatest in what ethnicitys/races
Mexican americans
Non-hispanic blacks
non-hispanic whites
131
control of car intake helps with what 4 things
weight control
blood sugar regulation
lower TGs
reduction in cavities
132
unintentional geriatrci weight loss is considered what
more than 10lbs in 6 months
133
Colorado Law:
Forward-facing with a ___ until they are at least ____
-Forward facing car seat if __ AND ___
Forward-Facing with a 5 point harness until they are at least 40 lbs
-If older than 1 year AND greater than 20 lbs
134
recommendations for breast CA screening
- reasonable every 1-2 yrs from 50-74y/o
| - self exams are reasonable
135
what happens to liver fxn w/ age?
- Liver mass decreases between 20 and 40 percent with age
| - Reduction of LDL metabolism and higher serum levels of LDL
136
Back Seat of Car
| Until ___ or ____
Back Seat of Car
| Until age 13 or 100 lbs
137
grades from the USPSTF
A, B, C, D, I
| from best to worst
138
preventative medicine for geriatrics
- Ca and VitD for ALL at fall risk
| - ASA for men 45-79w/ risk and women 55-79
139
- Peripheral nerve injury causing a CNS response
- Activation of the sympathetic NS leading to a peripheral nerve response
- Emotional triggers cause catecholamine release activating sympathetic nervous system
CRPS (complex regional pain syndrome)
*formally called RSD
140
crying peaks at __ age
2 months of age and tends to be worse in evenings
141
enroll child in swim lessons btwn what ages>
1-4 yrs of age
*avoid floaties or water wings --> use life jacket
142
sleep promblems w/ geriatrics are often caused by
```
psychiatric or medical condition: depression,
OSA,
urinary problems,
pain,
medications,
COPD,
GERD,
neurological disorders
```
143
what should the sleep position be?
supine (reduces SIDS risk by 50%)
- prone and side are SIDS risk factor up to 1 year of age
144
A _____ is one that is controlled by a single locus in an inheritance pattern
A Mendelian trait is one that is controlled by a single locus in an inheritance pattern
(single gene)
145
T/F: Patients not meeting NLST criteria will get equal benefit from LDCT
False
*Persons who do not meet the minimum eligibility criteria for the NLST may have less net benefit
146
```
Severe obesity,
restrictive lung
disease,
may lead to right heart
failure, hypoxemic
respiratory drive
```
obesity hypoventilation syndrome
147
what PE do u do when someone presents w/ pain neck pain w/ lateral rotation-facet mediated
facet loading
148
____: assess the likelihood of the presence of a disease or condition in apparently healthy or ASYMPTOMATIC individuals who are at sufficient risk for a condition to benefit from further investigation or preventive action.
Screening: assess the likelihood of the presence of a disease or condition in apparently healthy or asymptomatic individuals who are at sufficient risk for a condition to benefit from further investigation or preventive action.
149
___% of older people are infected with H. pylori
over 50%
150
how much of the worlds population is geriatrics
over 2 billion worldwide or 20% of the world’s population
151
what PE do you do w/ someone w/ pain with twisting, hurts to move from sitting to standing
(pain w/ lateral rotation- facet mediated)
facet loading
152
to dx CRPS you need the sx of __ and 1 symptom in what 4 categories
1. Sensory (Hyperesthesia -increased sensitivity to sensory stimulus), hyperalgesia, allodynia
2. Vasomotor changes (temp abnormalities, skin color changes, skin appearance changes)
3. Sudomotor changes (fluid retention, edema, sweating abnormalities, hair pattern changes
4. Motor changes (stiffness, decreased ROM, weakness, tremor)
153
what adult races/ethnicities have the highers prevalence of obesity
blacks
hispanics
whites
154
how much physical activity should everyone have per day
60 min of moderate exercise
*sedentary time less than 2 hrs
155
where should smoke detectors and CO detectors be placed?
smoke detectors- in every room
-CO- near bedrooms
156
successful weight loss is defined by what?
5% or more reduction in baseline weight at 1+ yr f/u of initial treatment
157
____: proportion of people with a positive test result who have the target disorder
Positive Predictive Value: proportion of people with a positive test result who have the target disorder
158
___ : all the DNA (the genome)
___: all the coding DNA (the exons)
___: all the proteins
____: all metabolites
- Genomics: all the DNA (the genome)
- Exomics: all the coding DNA (the exons)
- Proteomics: all the proteins
- Metabolomics: all metabolites
159
Motor exams w/ associated dermatomes to assess back pain
Tibialis anterior- foot dorsiflexion--L4
Extensor Hallucis longus--Big toe dorsiflexion-- L5
Peroneus longus/brevis
External rotation of foot/5th toe--S1
160
when to get an xray w/ back pain
- not improving w/initial tx
- suspect vertebral fracture
- hx of fusion
- spinal instability (flexion/extension views)
161
6 types of dementia
- Alzheimers (60-80%),
- Dementia with Lewy Bodies,
- Frontotemporal,
- Vascular,
- Parkinson’s,
- Etoh related
162
Which screening tools have been shown in AN RCT to decrease risk of dying from colon cancer?
sigmoidoscopy
gFOBT (guaiac)
163
a pedigree contains what type of information?
-contains biological, social, and psychosocial information
164
what are the 5 vulnerable periods for weight gain?
- infant "catchup" weight gain
- childhood/puberty/adolescence
- adulthood
- gestational weight gain
- menopause
165
what happens to kidney fxn w/ age?
- Renal mass decreases by 25 to 30 percent between the ages of 30 and 80 years, with the steepest decline after age 50.
- Creatinine clearance decreases with age (7.5 to 10 mL per minute per decade)
- ALL renal related functions diminish with time and nephrotoxicity related to medications, IV contrast, dehydration, and UTIs are common
166
normal sleep changes w/ geriatrics
-- older adults take longer to fall asleep and have more
nighttime wakefulness and more daytime napping
-- An earlier bedtime and wake time are common
167
orthopedic comorbidities associated w/ childhood obesity
- slipped capital femoral epiphysis (More likely to progress to bilateral disease in obese)
- Blounts disease
168
Sciatic nerve pain rarely goes beyond what
the knee
169
interventional therapies for CRPS:
____ blocks for upper extremity symptoms
____ blocks for lower extremity symptoms
Cervical ganglion blocks for upper extremity symptoms
Lumbar sympathetic blocks for lower extremity symptoms
170
leading cause of death for children over 3
Motor vehicle crashes
5000 children and adolescents die in crashes
171
sx: Dyspnea, edema,
| somnolence
obesity hypoventilation syndrome
172
the goal of healthy people 2020 was to increase prevalence of healthy weight among adults to __% and reduce the prevalence of obestiy among adults to __%
34%
less than 30%
173
presents w/
- Symmetric Flaccid Paralysis
- Absent Achilles reflex bilaterally
- Absent anal reflex
- numbness and tingling in groin
Cauda equina syndrome
*surgical emergency
174
10 components of geriatric assessment
1) Functional status
2) Fall Prevention
3) Nutrition
4) Vision
5) Hearing
6) Depression
7) Insomnia
8) Advanced Care Preferences
9) Cognition
10) Polypharmacy
175
Limit internet time to __ hours/day
Limit internet time to 2 hours/day
176
what reflexes and associated dermatomes do you check w/ neck pain?
biceps relfex --C5
Brachioradialis reflex-- C6
Triceps reflex --C7
177
dermatomes on feet to check for back apin
Big toe--L4
2nd, 3rd, and 4th toes--- L5
little toe/lateral foot S1
178
how to assess adequate intake for babies
-Maximum weight loss after birth =/less than 7% birth weight
-Rate weight gain (~30 g/d x 1-2 mo)
-Voiding: 6-8 “wet” diapers/d; urine should be dilute, clear; urate crystals = sign of dehydration/ inadequate intake
Stooling: “milk stools” by ~3 d; stool ~q feed; mustard/cottage cheese; after 5-6 wk may stool less frequently than formula fed infant;
179
what are traditional risk factors for obesity in adults
- HTN
- glucose intolerace/DM2
- dyslipidemia
- waist circumference
180
what vision problems come w/ age
cataracts
glaucoma
macular degeneration
abnormalites w/ accommodation
181
all children ____ years must be in a child restraint system
under 8
* must be in the rear seat of the vehicle
* use tether system and LATCH whenever possible
182
how do you test for peripheral nerve entrapment of the ulnar nerve?
Cubital Tunnel Test
| Tinel’s at medial aspect of elbow
183
geriatric poor nutrition may reflect what
medical illness
depression
functional losses
financial hardship
(MEALS ON WHEELS)
meds, emotional problems, anorexia, late-life paranoia/alcoholism, swallowing disorder, oral factors, no money, wandering, hyperthyroidism/hyperparathyroidism, entry problems/malabsorption, eating problems, low salt/cholesterol, shopping/food prepareness
184
The prevalence of dementia doubles every 5yrs starting at age __ approaching 50% by age ___
65
90
185
sx: bowed legs +/- knee pain
potentially disabling (genu varum)
-stress injury to medial tibial growth plate, often painless
-Blounts disease
186
motor exams/dermatomes for neck pain
- Deltoid/Biceps (C5)
- Biceps and Extensor carpi radialis longus and brevis (C6)--Wrist Extension
- Triceps, wrist flexors, and finger extensors (C7)
- Finger flexors, and interossei muscles (C8)--Spreading fingers apart
187
describe what happens w/ Ca reabsorption and colonic motility with age
-calcium absorption from the gut lumen decreases
( Typically, women over age 75 absorb 25 percent less of a given dose of calcium than younger women)
-colonic propulsive motility is reduced with age and about one-fourth of those over 65 years suffer from chronic constipation
188
How has mortality changed since screening for breast CA
Mortality has decreased by about 30% since screening began
189
T/F: detecting cancer early proves that cancer screening saves lifes
False- it only proves that you detected it early
190
Requirements of a successful screening program
1. Screening advances time of diagnosis of cancers destined to cause trouble
2. Early treatment is superior to treatment started after patient already has symptoms
191
Leading cause of recreational sports injury
bicycles
*Bicycle helmets can prevent ~88% of serious brain injuries
*Colorado does not have a statewide requirement for bicycle helmets for children
192
main sleep issues
1. suffocation
2. asphyxia due to entrapment
3. co-sleeping
193
atherosclerotic risks in obese children
fatty streaks
plauqe in coronaries
HTN
hyperlipidemia
194
fat should be ___% of daily intake of calories
20-35%
| -less than 10% from saturated fat
195
future approaches of PM and R
- stem cell therapy
| - platelet rich plamsa (PRP)
196
what tests do you do w/ someone w/ pain sititng, usually better w/ walking
(SI Joint pain)
- Patrick’s test/Faber
- Fortin Finger test (Tenderness just inside of the posterior superior iliac spines, Hip exam)
- palpate ASIS
197
____: proportion of a defined group of people who have a condition or disease at a given point in time
___: proportion of an initially disease-free group of people who develop the disease over a given period
Prevalence: proportion of a defined group of people who have a condition or disease at a given point in time
Incidence: proportion of an initially disease-free group of people who develop the disease over a given period
*Tracking prevalence and incidence over time can help to determine health care strategies aimed at limiting the burden of a disease
198
```
A new functional decline and loss of independence in one of the following:
• Learning and memory
• Language
• Executive function
• Complex attention
• Perceptual-motor function
• Social cognition
```
dementia
199
-the entire set of genetic
| instructions found in a cell
genome
200
5 Most effective behavioral therapy for adult weight loss
- Self-monitoring
- Assessing readiness to change
- Structured meal plans, meal replacements and portion control
- Goal setting
- Problem solving
201
what imaging could you get for CRPS if done early?
3 phase bone scan
202
- less than 4 weeks onset
| - In the absence of neurologic deficits and red flags conservative treatment is warranted
acute back pain
203
carbs should be ___% of daily intake of calories
45-65%
*no more than 100-150 calories a day from added sugar
204
use CDC BMI (kg/m2) charts for what age?
| and why?
2-20 yrs
* reflects weight relative to linear growth
* correlation w/ EXCESS ADIPOSITY in children
205
sx: Polyuria and polydipsia,
| unintentional weight loss
-DM2
206
Screen all adults born between 1945‐1965 one time for ___
hep C
207
what happens to esophageal contractions w/ age?
decreases
| -combined with decreased lower esophageal sphincter tone, results in increased gastric acid exposure – ie more GERD
208
Measurable impairment in one of the cognitive domains with preservation of independence and function
mild cognitive impairment (MCI)
209
Booster Seat OR Car Seat
Children ____ years of age
-Booster utilizes lap and shoulder belt
Booster Seat OR Car Seat
Children 4-8 years of age
* through their 8th birthday
- $80 fine
210
hearing problems w/ age
- hearing loss is common--> lead to social withdrawl
- check cerumen impaction
*Senile hearing loss is usually bilateral and in the high frequency range
211
What are the components of health maintenance visits?
- Screen for diseases
- Assess risk of future medical problems
- Encourage a healthy lifestyle
- Update vaccinations
- Maintain a relationship with a health care provider in case of an illness
212
___: proportion of people with a negative test result who are free of the target disorder
Negative Predictive Value: proportion of people with a negative test result who are free of the target disorder
213
who should be referred to bariatric surgery?
- Adults with BMI at or above 40
- BMI at or above 35 with obesity-related comorbidities
- Individuals who have not responded to other treatment
214
leading cause of death among children over 1 year
unintentional injury
-falls, burns, firearms, sports
215
geriatric vaccination recommendations
- annual flu (not live)
- Td booster every 10 yrs
- pneumococcal 1x over 65
- herpes zoster 1x over 60 (regardless if had chickenpox or shingles)
216
Screening ___ for lung cancer is the most beneficial cancer screening test we have – when applied to high risk patients
Screening LDCT (low dose chest CT) for lung cancer is the most beneficial cancer screening test we have – when applied to high risk patients
217
How has mortality changed since screening for CRC
-Declines in both incidence and mortality since the introduction of CRC screening
*this is quite different than what has been
observed with breast and prostate CA screening
218
screen what aged women for osteoporosis
over 65 or at high risk using BMD
219
set water temp to what?
less than 120F
220
what pulmonary conditions are common in children who are obese
obstructive sleep apnea
| obesity hypoventilation syndrome
221
Once patients are in their ____, consider backing off of common preventive medications and screenings
mid 70's-80s
222
leading cause of death (1-21yrs)
intentional injury
- homicide
- suicide
223
leading causes of death among older adults
- heart disease
- CA
- stroke
224
what ages are eligible for medicare?
65+
225
___ is most imporatnt SES predictor of childhood obesity worldwide
maternal education
226
___: impact of the disease on health and functioning
___: the degree to which a condition results in death
Morbidity: impact of the disease on health and functioning
Mortality: the degree to which a condition results in death
*prevention reduces morbidity and mortality
227
For every increase of 5 kg in adults the relative risk of what 3 things go up?
CHD (14%)
Stroke (4%)
Ischemic Stroke (16%)
228
do these supplements have evidence to help with weight loss
- Garcinia
- Glycerol
- Guar gum
- Inulin
possibly inneffective
229
Lifetime prevalence of low back pain is ____%
__ most common cause of primary care office visits
___most common cause of all physician visits
85%
2nd
5th
230
depression screening tools
PHQ2
PHQ9
GDS15
CSDD- for dementia w/ suspected depression
231
geriatrics w/ BP over/= ____ should be screen for DM
135/80
232
therapeutic approach to treating conditions/symptoms through a specifically tailored diet
medical nutrition therapy (MNT)
233
what type of prevention:
| interventions that reduce the risk of disease occurrence in otherwise healthy individuals.
primary prevention
234
sun safety for children less than 6 months?
- Dress in lightweight long-sleeved and pants
- Wide brimmed hat
- If no shade --> SPF 15
235
what happens to the pulsatile secretion of gonadotropins, growth hormone, thyrotropin, melatonin, and adrenocorticotropic hormone (ACTH) with age
attenuated /lessened
236
do these supplements have evidence to help with weight loss
- Caffeine
- Calcium (diet)
- Conjugated linoleic acid
- Diacylglycerol
- Ephedra (banned in US)
- Fish oil
- Vitamin D (obese deficiency)
possibly effective
237
consider screening patients on SSRIs for ___, possibly lower max dose of citalopram/ escitalopram
hyponatremia
238
Acute pain ___ weeks
| Chronic pain ___ months
Acute pain: less than 2 weeks
| Chronic pain: more than 6 months
239
___: the proportion of people with the target disorder who have a positive test result
Sensitivity: the proportion of people with the target disorder who have a positive test result
240
neurologic comorbidies associated w/ childhood obesity
Psuedotumor Cerebri
Prevention Across the Lifespan
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