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Family Medicine > FM CASE FILES 1 > Flashcards

FM CASE FILES 1 Flashcards

1
Q

What is Strabismus?

A

ocular misalignment

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2
Q

Define failure to thrive.

A
  1. weight below 3rd or 5th percentile, or

2. decelerations of growth that have crossed 2 major growth percentiles, in a short period

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3
Q

Most common cause of amblyopia.

A

Strabismus

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4
Q

Name 2 required newborn screening tests.

A

PKU and congenital hypothyroidism

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5
Q

Name some common newborn screening tests.

A

hemoglobinopathies (sickle), galactosemia

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6
Q

How do you evaluate for iron deficiency in children?

A

get hemoglobin or hematocrit bt 6-12 months of age

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7
Q

what is the meaning of a red reflex in an ophthalmoscopic exam of a newborn

A

no cataracts or retinoblastoma

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8
Q

how do you test for strabismus

what do you do if the child tests positive

A

asymmetric light reflex, or

cover-uncover test
child focuses on object with both eyes, then cover one eye, if the uncovered eye deviates then it is a sign of strabisumus

refer to ophthalmologist asap to prevent amblyopia

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9
Q

leading cause of death in children under 1yo

A

SIDS

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10
Q

what is the car safety law for children

A

rear-facing car seat until 1yo and weighs 20 lbs

front-facing seat btw 20-40 lbs

booster seat when >40lbs, with shoulder belt

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11
Q

leading cause of death of children older than 1 yo

A

accidents and injuries

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12
Q

contraindications to vaccines

A

hx of anaphylactic reaction to vaccine or its component (regardless if having fever or not)

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13
Q

sx: nasal itching, sneezing, rhinorrhea

A

allegic rhinitis

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14
Q

signs: nasal turbinates swollen (boggy), pale/bluish color

A

allergic rhinitis

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15
Q

tx for allergic rhinitis

A

antihistamines, decongestants or intranasal steroids

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16
Q

complications of tx for allergic rhinitis

A

excess use of decongestants can cause rebound congestion

rhinitis medicamentosa

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17
Q

name sx of allergic rhinitis

A 
sneezing
itching (nose/eyes/ears)
rhinorrhea - thin/watery
postnasal drip
congestion
anosmia
HA
earache
tearing/red eyes
drowsiness
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18
Q

contrast the mucous secretion of rhinitis vs sinusitis

A

rhinitis - thin/watery

sinusitis - thick/purulent

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19
Q

how do you test for nasal polyps

A

spray a topical decongestant, the polyp does not shrink, but the surrounding nasal mucosa does

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20
Q

name some 1st gen antihistamines

A

diphenhydramine
chlorpheniramine
hydroxyzine

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21
Q

name some 2nd gen antihistamines

A

loratadine
fexofenadine
cetirizine

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22
Q

why do 2nd gen antihistamines have less sedative effects than 1st gen

A

less penetration into cns

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23
Q

name a decongestant and its mech of action

A

pseudoephredine

alpha agonst

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24
Q

why avoid oral decongestants

A

may cause tachycardia, tremors, insominia

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25
Q

side effects of corticosteroid nasal sprays

A

nosebleeds, pharyngitis, URI

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26
Q

describe urticaria

A

large, irregularly shaped
pruritic
erythematous wheals

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27
Q

describe angioedema

A

painless
deep
subcu swelling

involves:
periorbital
circumoral

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28
Q

describe anaphylaxis

A 
systemic rxn:
skin findings
dyspnea
visceral edema
hypotension
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29
Q

immediate tx for anaphylaxis

A

epi

SQ or IM

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30
Q

what is asthma

A

msucle spasms

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31
Q

signs/sx

asthma

A 
wheezing
SOB
cough
increase airway sections
increased expiratory phase
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32
Q

what 2 major triggers of asthma

A

viral infx

allrgens

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33
Q

acute relief of asthma

A

beta2 agonist

albuterol

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34
Q

tx for persistent asthma

A

long acting b2 agonist (salmeterol)

inhaled corticosteroids

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35
Q

bacterial conjunctivitis

name them

A 
staph
strep
hemophilus
moraxella
pseudomonas
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36
Q

cause of pink eye

A

adenovirus

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37
Q

how is conjunctivitis spread

A

by direct contact

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38
Q

smoking cessation interventions

A

meds: buproprion

nicotine replacement:
gum, patch, inhaler, nasal spray

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39
Q

5As a physician should use to assist in smoking cessation

A 
ask about tobacco use
advise to quit (talk about risks/benefits)
assess willingness to quit
assist to quit
arrange follow-up/support
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40
Q

buproprion contraindicated in what kinds of pts

A

seizures
eating disorders
MAO-I

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41
Q

can pregnant women use the nicotine or buproprion to stop smoking

A

yes

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42
Q

are physicians required to report STIs?

A

YES!

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43
Q

what is emancipation

A

legal process to declare a person under 18 a legal adult: housing, education, healthcare, conduct

but u still cannot drink EtOH, smoke or vote

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44
Q

besides emancipation, what is another way a child may consent to receive medical care w/o parents

A

“Mature Minor Doctor”

court may deem the child to be “mature”

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45
Q

what are the moral principles of ethics

A

autonomy - patient choice
beneficence - do right for patient
nonmaleficence - do no harm
justice - be fair and nonbiased

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46
Q

reliable sign of anemia in elderly

A

conjunctival pallor

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47
Q

general signs of anemia

A

fatigue
weaknesss
dyspnea

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48
Q

general signs of vit b12 def

A 
glossitis
decreased vibratory/positional senses
ataxia
paresthesia
confusion
dementia
pearly gray hair
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49
Q

initial workup of anemia

A

cbc
peripheral blood smear
retic count

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50
Q

iron panel results for iron def anemia

A

low iron
low ferritin
high TIBC

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51
Q

how do u confirm vit b12 def

A

elevated methylmalonic acid

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52
Q

other diseases or conditions causing vit 12 def

A

pernicious anemia
history of gastrectomy

is associated w/ malabsorption (bacterial infxn, crohn dis, celiac)

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53
Q

folate def is assoc with what condition

A

alcoholism

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54
Q

causes of acute diarrhea

A

virus

bacteria (e coli, campylobacter, shigella, salmonella, giardia)

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55
Q

causes of chronic diarrhea

A 
crohns
UC
gluten intolerance
IBS
parasites
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56
Q

bacterial causes of bloody diarrhea

A

e coli
yersinia
shigella
e histolytica

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57
Q

stool leukocytes is indicative of what orgs

A 
salmonella
shigella
yersinia
e coli
c dif
campylobacter
e histolytica
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58
Q

travelers diarrhea

A

enterotoxigenc e coli

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59
Q

campers diarrhea

A

giardia

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60
Q

daycare diarrhea

A

shigella
giardia
rotavirus

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61
Q

diarrhea from nursing homes or recent hospitalization

A

c dif colitis from antibiotic use

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62
Q

how do u check for c dif colitis

A

stool c dif toxin

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63
Q

first step in tx of diarrhea

A

fluid resuscitation and electrolytes

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64
Q

best way to prevent viral diarrhea

A

handwashing

65
Q

tx for traveler’s diarrhea

A

quinolone (cipro 500mg bid)
for 1-2 days

or azithromycin

bactrim is more resistant now so avoid it

66
Q

bugs in each diarrhea time course:
within 6 hours
8-12 hours
12-14 hours

A

s aureus
c perfringens
e coli

67
Q

how to reduce risk of developing osteoporosis

A

daily Ca2+ / Vit D

weight-bearing exercise

68
Q

how often do u do mammograms

A

start at 40

every 1-2 yrs after that

69
Q

screening for HTN in adults

A

starts at 18

measure blood pressure

70
Q

lipid screening guidelines

A

lipid screen starting at 45yo for women

71
Q

how long should HRT be used

A

lowest dose

as short as possible

72
Q

when to start screening for cervical cancer

A

21

or within 3 yrs of having sex

73
Q

how is screening for osteoporosis done

A

dexa scan (bone density)

74
Q

which joint is most likely to be affected in osteoporosis

A

hip

75
Q

osteoporosis is present if dexa results should a t-score is below what value

A
  • 2.5

2. 5 SD below a young woman’s

76
Q

how do u dx osteopenia

A

dexa scan

T value = -1 to -2.5

77
Q

mech of injury of an ankle sprain

A

inversion of ankle while plantar flexed

78
Q

most commonly injured ligament in ankle sprain

A

lateral ankle more injured than medial ankle

anterior talofibular ligament

79
Q

what is a grade 1 ankle sprain

A

stretching of the ATFL
(anterior talofibular ligament)

pain and swelling
no mechanical instability or loss of fxn

80
Q

what is a grade 2 ankle sprain

A

partial tear of ATFL
stretching of CFL (calcaneofibular lig)

severe pain, swelling, bruising
mild-to-moderate joint instability, pain with weight bearing, loss of ROM

81
Q

what is a grade 3 ankle sprain

A

complete tear of ATFL and CFL
partial tear of PTFL (posterior talofibular ligament)

signifcant joint instability
loss of fxn
inability to bear weight

82
Q

ottawa rules

when do u perform a foot x-ray

A

bony tenderness over:
navicular bone (medial midfoot)
base of 5th metatarsal (lateral midfoot)
unable to bear weight (immed or during exam)
posterior edge or tip of medial/lateral malleolus

83
Q

management of ankle sprain

A 
PRICE
protection (splint/cast)
rest
ice (minimize swelling/pain)
compression (reduce swelling)
elevation (reducing swelling)

NSAIDs / acetaminophen

84
Q

how do you test for supraspinatus injury/tear

A

Empty Can Test

with arm abducted, elbow extended, thumb point down

patient elevates arm against resistance

85
Q

how do you test for infraspinatus or teres minor injury/tear

A

External Rotation

with elbows at side and flexed at 90 degrees

patient externally rotates against resistance

86
Q

how do you test for subscapularis tear

A

Lift-Off Test

patient places dorsum of hand on lumbar back and attempts to lift hand off of back

87
Q

how do you test for ATFL injury or tear

Anterior Talofibular Ligament

A

Anterior Drawer

pull forward on pts heel while stabilizing lower leg

excess translation of joint suggests ATFL tear

88
Q

how do you test for CFL injury or tear

Calcaneofibular Ligament

A

Inversion Stress Test

invert ankle with one hand while stabilizing lower leg with other

excessive translation or palpable “clunk” of talus on tibia suggests ligament tear

89
Q

how do you test for syndesmosis injury

A

Squeeze Test

examiner compresses tibia/fibula at midcalf

pain at anterior ankle joint (where you’re squeezing) suggests syndesmotic injury

90
Q

how do you test for ACL injury/tear

A

Lachman Test or Anterior Drawer

put knee in 20 degree flexion
pull forward on upper tibia

91
Q

howd you test for MCL injury/tear

A

Valgus Stress

in full extension and at 30 degree flexion, medial-directed force on knee, lateral directed on ankle

look for excess translation

92
Q

how do you test for LCL injury/tear

Lateral Collateral Ligament

A

Varus Stress

in full extension and at 30 degree flexion, lateral-directed force on knee and medial-directed force on ankle

93
Q

according to ottawa knee rules, perform knee x-ray when….

5 things

A 
age 55 orolder
isolated patella tenderness
fibular head tenderness
can't flex knee to 90
can't bear weight for 4 steps 
(then or now, regardless of limp)
94
Q

if x-ray of joint is normal, but symptoms persist, whats the next test

A

MRI

95
Q

most common cause of persistent stiff or painful joints following sprains

A

inadequate rehab

96
Q

single most important risk factor for development of skin cancer

A

exposure to UV radiation (sun)

97
Q

what are risk factors for skin cancer

A 
prior history of skin cancer
family hx of skin cancer
fair skin
red/blonde hair
burn easily
exposure to chemicals (arsenic, radium)
suppressed immune system

exposure to UV radiation

98
Q

most common type of melanoma

A

superficial spreading melanoma

radial growth phase is slower than vertical phase (grows into dermis and can metastasize)

99
Q

most common type of melanoma in the elderly and hawaii

A

lentigo maligna

found on chronic sun-damaged skin (face, ears, arms and upper trunk)

(however this is the least of the 4 in total)

100
Q

most common type of melanoma in african-american and asians

A

acral lentiginous melanoma

found under nails
soles of feet
palms of hands

101
Q

most aggressive type of melanoma

invasive at time of dx

A

nodular melanoma

102
Q

ABCD of Melanoma

A

a - asymmetry (symm vs asymm)
b - border (defined vs ragged)
c - color (uniform vs variegated)
d - diameter (less vs greater than 6 cm)

103
Q

tx for benign melanoma

A

monitor

educate patient

104
Q

tx for suspicious melanoma

A

excise with 2-3 mm margin

105
Q

how do you excise malignant melanomas

A

5 mm margin

if on face, refer to plastic surgeon

106
Q

what is follow-up after excising a melanoma

A

annual follow-up

observe for new/changing lesions

107
Q

most important prognostic indicator for melanoma

A

thickness of tumor
(aka breslow measurement)

less than 1mm thick has low rate of metastasis

108
Q

how to prevent melanomas

A

reduce exposure to UV radiation
clothe properly
sun-screen

109
Q

describe basal cell carcinomas

A

pearly papules
central ulceration
multiple telangiectasias
bleeds or itches

110
Q

tx for bcc

A

excision

rarely metastasizes

111
Q

which metastasizes more: scc or bcc

A

scc

112
Q

describe scc

A

irregularly shaped plaques or nodules with raised borders
scaly
ulcerated
bleed easily

113
Q

tx for scc

A

excision

114
Q

how do you image the upper urinary tract

A

IV Pyelo

115
Q

how do you image the lower urinary tract

A

cystoscopy

116
Q

define microscopic hematuria

A

> 3 RBC per HPF
from 2-3 Ua tests

freshly voided
morning
clean catch
midstream urine

117
Q

eos in the urine

A

interstitial nephritis

118
Q

how long does exercise-induced hematuria last

A

less than 72 hours

119
Q

pt with hematuria, has repeat Ua showing hematuria again, what do you do next

A

full work-up

Ua
microsopy of urinary sediment
Ucx to r/o UTI
BMP to get Cr –> focus on renal cause if elevated (May need renal bx)

120
Q

what exactly is an IVP

A

x-ray of urinary tract after administration of contrast

121
Q

CT with or without contrast to look for calculi

A

non-con

122
Q

complication of CT with con or IVP

risk factor for it

how do you prevent it

A

nephropathy

renal insufficiency

premedicate with N-acetylcysteine

123
Q

if patient has renal insuff, whats another way to evaluate for upper urinary tract

A

retrograde pyelography with renal ultrasound

place catheter in the bladder and inject contrast up ureter to kidneys

124
Q

how do you examine for transitional cell carcinoma

A

cystoscopy

125
Q

patient with hematuria, but with a thorough negative work-up

what do you do now?

A

do BP measurements
Ua
voided urine ctyologic studies

all done at 6, 12, 24 and 36 months

basically you’re looking for any underlying lesions, after this if they are still asymptomatic, then no further tests required

however, if they still have sx (i.e. hematuria, dysuria, develops HTN, proteinuria, casts), refer to urologist

126
Q

is radioactive iodine therapy safe in pregnant woman

A

no

radioactive isotope can cross placenta and cause fetal thyroid ablation

alternative: surgical removal of thyroid

127
Q

meds for graves

A

antithyroid drugs (PTU and methimazole)

beta-blockers to counter peripheral effects

these are only temporary

128
Q

definitive tx for graves

A

radioactive iodine

destroys thyroid gland

129
Q

signs and sx

thyroid storm

A

fever
confusion
restlessness
psychotic-like behavior

tachycardia
elevated BP
dysrhythmias
dyspena on exertion
peripheral vasoconstriction
130
Q

signs and sx

hyperthyroidism

A 
nervous
palpitations
wt loss
fine resting tremor
dyspnea on exertion
difficulty with concentration
131
Q

50% of graves has this finding

A

exophthalmos

132
Q

how do you diagnose hyperthyroidism

A

low TSH

high Free T4

133
Q

you suspect graves dz

whats your next step

A

imaging with technetium-99

its a radionucleotide scan

tells you active/inactive areas
usually DIFFUSE uptake

134
Q

radionucleotide scan in thyroiditis vs graves

A

graves - diffuse uptake

thyroiditis - patchy uptake

135
Q

how does PTU and methimazole work?

A

inhibits organification of iodine

PTU also prevents peripheral conversion of T4 to T3

136
Q

side effect of PTU and methimazole

A

agranulocytosis

137
Q

is PTU and methimazole safe during pregnancy

A

YES

PTU is preferred however

138
Q

for graves, when is surgery indicated

A

pregnant women
cannot tolerate side effects of PTU
large goiter compressing nearby structures

139
Q

signs and sx of hypothyroidism

A 
lethargy
weight gain
hair loss
dry skin
slow mentation/forgetfulness
constipation
intolerance to cold
depression
140
Q

in elderly, differential dx for dementia

A

alzheimers

hypothyroidism

141
Q

side effect of PTU and methimazole

A

agranulocytosis

142
Q

is PTU and methimazole safe during pregnancy

A

YES

PTU is preferred however

143
Q

for graves, when is surgery indicated

A

pregnant women
cannot tolerate side effects of PTU
large goiter compressing nearby structures

144
Q

signs and sx of hypothyroidism

A 
lethargy
weight gain
hair loss
dry skin
slow mentation/forgetfulness
constipation
intolerance to cold
depression
145
Q

in elderly, differential dx for dementia

A

alzheimers

hypothyroidism

146
Q

in women, differential dx for depression

A

depression

hypothyroidism

147
Q

physical findings of hypothyroidism

A 
low BP
bradycardia
nonpitting edema
hair thinning or loss
dry skin
diminished relaxation of reflexes
148
Q

most common cause of hypothyroidism

A

Hashimoto thyroiditis

149
Q

what are secondary causes of hypothyroidism

A

hypothalamic or pituitary dysfxn

pts received intracranial irradiation or surgical removal of a pituitary adenoma

150
Q

dx of primary and secondary hypothyroidism

A

primary:
high TSH
low Free T4

secondary:
low tsh and free T4

151
Q

how would you distinguish between hypothalamic vs pituitary hypothyroidism

A

inject TRH

if TSH increases, its a hypothalamus problem

if TSH remains low, its a pituitary propblem

152
Q

as you age, you may need to decrease levothyroxine dosage

why?

A

thyroid binding to albumin decreases b/c albumin also decreases with age

monitor TSH annually in elderly

153
Q

you find thyroid nodules on PE
what do you do next?
why?

A

evaluate thyroid fxn (tsh/t4)

functional adenomas with hyperthyroidism are rarely malignant

to rule out malignancy in solitary nodules

154
Q

risk factors for thyroid malignancy

A

history of head/neck irradiation
family hx of thyroid cx
cervical LA
recent development of hoarseness of voice

155
Q

tx for hyperfunctioning thyroid nodules

A

surgery

radioactive ablation

156
Q

nonfunctioning thyroid nodules

what do you do next?

A

assuming you found this nodule by ultrasound or physical exam

FNA biopsy

157
Q

FNA of thyroid nodule is INDETERMINATE

whats the next step

A

you need a definitive dx by surgery only

this is b/c indeterminate means that you cannot distinguish between follicular cell malignancy from its benign equivalent

158
Q

tx for thyroid malignancy

A

thyroidectomy

followed by radioactive ablation

159
Q

pregnant woman with thyroid nodule

next step?

A

FNA to find out what it is
thyroidectomy is SAFE
radioisotope scan is CONTRAINDICATED

or just wait til postpartum period b/c thyroid cancer is relatively indolent

Family Medicine (6 decks)

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