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Family Medicine > FM CASE FILES 3 > Flashcards

FM CASE FILES 3 Flashcards

1
Q

benefits of breast feeding

A

faster return of uterine tone (reduced bleeding)
quicker return to prepregnant wt
reduced incidence ov ovarian/breast cx
lower cost

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2
Q

what hormonal contraception is recommended in breast-feeding women

A

progestin-only “mini-pill”

avoid combined pills b/c it interferes with milk supply

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3
Q

how long does uterus take to return to prepregnant size after labor

A

6 weeks

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4
Q

white/yellow discharge in weeks following labor

A

this is normal and is called lochia

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5
Q

when does ovulation and menstruation return after pregnancy

A

for non breast feeding mothers = 3 months

longer if you are breast feeding

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6
Q

common causes of postpartum hemorrhage

A

4Ts

uterine atony
trauma (lacerations)
retained Tissue (placenta)
thrombin (coagulopathies)

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7
Q

most common cause of postpartum hemorrhage

A

uterine atony

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8
Q

tx for uterine atony

A

oxytocin and bimanual uterine massage

if fails, give methylergonovine
contraindicated in pts

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9
Q

sign and sx

endometritis after labor

A

postpartum fever
uterine tenderdness
smelly lochia

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10
Q

how do u reduce risk of endometritis

A

abx prophylaxis during delivery

cover vaginal and GI flora

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11
Q

duration of maternity blues

A

gone by 10 days after labor

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12
Q

tx of depression in breast-feeding mothers

A

SSRIs

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13
Q

how soon should women be allowed to breast feed after labor

A

asap

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14
Q

what is in colostrum

A

antibodies!

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15
Q

what is mastitis?

should she stop breast feeding?

A

obstruction of milk glands then becomes infected

no, keep pumping away

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16
Q

how long after labor to start OCPs

A

6 weeks

3 if not breast feeding

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17
Q

is depo provera ok in breast feeding women

A

yes

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18
Q

how long after labor can she resume IUD or diaphragms

A

6 weeks

get re-fitted

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19
Q

what is diastolic vs systolic chf

A

systolic - dilated LV and impaired contractility

diastolic - normal LV but impaired relaxation

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20
Q

sensitive and specific marker for CHF

A

BNP

> 500

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21
Q

cxr finding in CHF

A

cephalization of pulmonary vasculature

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22
Q

initial management of CHF

A

ABCs
then O2

if pulmonary edema, start diuretic

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23
Q

first line tx of CHF

A

ACE-I

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24
Q

CHF

what benefits do beta blockers offer

A

reduce sympathetic tone

reduce cardiac muscle remodeling

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25
Q

3 meds in CHF

A

ACE-I
beta blockers
diuretics

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26
Q

use ccb in systolic CHF?

A

NO they are contraindicated

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27
Q

when would you use ccb in CHF

A

in DIASTOLIC CHF

promotes increased cardiac output by lowering HR
allows for more ventricular filling time

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28
Q

benefits of combination OCPs

A

protects against ovarian/endometrial cx
protects against iron-def anemia
PID
fibrocystic disease

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29
Q

how do combo OCPs work

4 things

A

suppresses ovulation
thickens cervical mucus
retards sperm entry
discourages implanation

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30
Q

side effects of OCPs

A 
Nausea
HA
breast swelling
fluid retention
weight gain
irregular bleeding
depression
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31
Q

what to do if OCP pill is missed

A

take it asap

take next dose as usual

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32
Q

if two pills are missed in OCP

A

take 2 pills together 2 days in a row

and use alternative contraception for 7 days

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33
Q

how long does depo-provera last

A

14 weeks

so inject every 3 months

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34
Q

failure rate of spermicides

how about when combined with condoms

A

20-30%

down to that of OCPs

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35
Q

emergency contraception

works when taken within how many hours

A

72

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36
Q

in adolescents, screen them for sports participation

what are you looking for?
what are signs/sx?

A

hypertrophic cardiomyopathy
murmur left sternal border
accentuates with activities that decrease cardiac preload and EDV of LV
(i.e standing or straining with valsalva maneuver would increase murmur; while squatting would decrease murmur)

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37
Q

nonpharm tx of HTN

A

DASH
Dietary Approaches to Stop HTN

high K+ and Ca2+
effective as a single agent antihypertensive therapy

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38
Q

goal BP for HTN

waht about for DM pts

A

< 140/90

< 130/80

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39
Q

how do you diagnose HTN

A

two PROPER measurements on two occasions

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40
Q

signs and sx

intussusception

A

abdominal pain
crying (infants)
periods of pain-free / no crying

SAUSAGE SHAPED MASS
currant jelly stool (red mucousy)

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41
Q

x-ray of intussusception

A

coiled spring

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42
Q

diagnostic test for intussusception

A

barium enema

its also therapeutic

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43
Q

x-ray shows perforation in intussusception

whats the next step

A

surgery

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44
Q

how does vomiting present in intussusception

A

vomiting gradually becomes bilious as obstruction sets in

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45
Q

where do most intussusception occur

A

right lower quadrant

ileocecal jxn

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46
Q

signs and sx

malrotation in a child

A

bilious vomiting and abdominal pain

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47
Q

complication of malrotation

A

twisted bowel will become necrotic

causing fluid loss and sepsis

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48
Q

imaging findings on malrotation

A

misplaced duodenum or obstruction

beaklike appearance caused by volvulus

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49
Q

tx for malrotation

A

surgery

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50
Q

which objects require immediate intervention in a foreign body complication

A

batteries

if both poles touch the esophageal wall, it will conduct electricity and PERFORATE

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51
Q

what is aphasia

A

cannot understand words

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52
Q

what is apraxia

A

lost of muscle coordination

cannot perform complex tasks involving muscles

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53
Q

what is agnosia

A

cannot recognize common objects

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54
Q

what is pseudodementia

A

depression in the elderly which “appears” as alzheimers

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55
Q

tx for alzheimers

A

cholinesterase inhibitors

donepezil
rivastigmine
tacrine
memantine

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56
Q

what is vascular dementia

A

memory loss from STROKES

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57
Q

compare vascular with alzheimers dementia

A

alzheimers - GRADUAL

vascular - SUDDEN ONSET, STEPWISE FASHION loss as subsequent infracts occur

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58
Q

signs and sx

NPH

A

urinary incontinence
gait disturbance
dementia

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59
Q

contrast lewy body vs alzheimers dementia

A

lewy body - hallucinations early on

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60
Q

tx for obesity

A

diet AND exercise….one alone is not good enough

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61
Q

metabolic syndrome

5 things

A 
waist > 40 in (men) or 35 in (women)
triglycerides >150
HDL < 40 (men) and 50 (women)
BP > 130/85
fasting glucose > 110
62
Q

signs and sx

migraines

A 
pulsating HA
unilateral
photophobia
phonophobia
worsens with activity
multiple attacks lasting hours to days
NV
63
Q

diagnosis?

headache with fundoscopic showing papilledema

A

increased intracranial pressure

64
Q

when should u image a pt with migraines

A

if he/she has “red flags”:

HA with head trauma - hemorrhage
sudden onset HA - hemorrhage
inc severity/freq - mass/hematoma
HA after 50yo - temporal arteritis, mass lesion
HA in AIDS pt - meningitis
HA with neck stiff - meningitis
HA with focal neurol signs - stroke
65
Q

tx for migraines

A

triptans
ergotamine
NSAIDs

66
Q

signs and sx

tension HA

A

bilateral bandlike distribution

no aggravation with activity
no NV
no photophobia / phonophobia

67
Q

tx for tension HA’s

avoid what

A

caffeine and ergotamine drugs

68
Q

signs and sx

cluster HA

A

unilateral
orbital / supraorbital / temporal

PACES AROUND - unable to find a comfortable position

69
Q

contrast cluster vs migraines

A

migraines - wants to stay in one place

cluster - PACES AROUND

70
Q

what are screening recs for lipids?

A

starting at 20yo

then ever 5 yrs after that

71
Q

how do u screen for cholesterol?

A

fasting lipid panel (total, LDL, HDL, trig)

or

nonfasting total and HDL with subsequent fasting lipid panel if total is > 200 or HDL < 40

72
Q

which class of drugs are best to lower LDL

73
Q

which class of drugs are best to lower Triglycerides

which have no effect on triglycerides

A 
nicotinic acids (niacin)
fibrates (gemfibrozil)

bile acids

74
Q

side effects

niacin

A

facial flushing

75
Q

side effects

statins

A

muscle pain

76
Q

side effects

bile acids

A

constipation

decreased absorption of other drugs

77
Q

contraindications

niacin

78
Q

contraindications

fibrates

A

severe kidney or liver disease

79
Q

bucket-handle fracture of long bones in children

80
Q

circumferential hematoma of anus of child

81
Q

retinal hemorrhages in child

A

shaken baby syndrome

abuse

82
Q

describe slipped capital femoral epiphysis

A

seen in overweight pts

pain with internal rotation of hip
external rotation during passive flexion

83
Q

how pts with septic hip joint position their legs

A

flex at hip
abducted
externally rotated

84
Q

definitive dx of septic joint

A

joint aspiration

85
Q

most common cause of septic joint

A

< 4 mo
GBS
s aureus

< 5yo
s aureus
s pyogenes (GAS)

86
Q

what is toddler’s fracture

how do you diagnose it

A

spiral fracture of tibia when twisting while foot is planted

x-ray

87
Q

congenital dysplasia of hips

pain or no pain

A

painless limp

88
Q

joint complication of viral illness

A

transient synovitis

89
Q

lab findings on transient synovitis

A

normal WBC

normal ESR

90
Q

tx for slipped capital femoral epiphysis

A

surgical pinning of femoral head

91
Q

causes of postop fever

A 
5Ws
water - uti
wind - pna
wound - incisional infxn
walk - dvt
wonder drugs
92
Q

which drugs cause wonder drugs

A

beta lactams
sulfas
heparin
amphoterrible

93
Q

causes of immediate postop fever

A

malignant hyperthermia
(b/c of anesthetics halothane and succinylcholine)

bacteremia

94
Q

cxr findings on postop atelectasis

A

elevated hemidiaphragm

discoid infiltrate

95
Q

what kind of pain in DVT pts

what maneuver can u use

A

calf pain

homan’s sign
pain in calf on foot dorsiflexion

96
Q

most common cause of wheezing in children

A

bronchiolitis

RSV

97
Q

signs and sx

bronchiolitis

A

at first, rhinorrhea/wheezing
then fever

then gets worst
coughing starts

98
Q

define

croup

A

inflammation of subglottic region

99
Q

signs and sx

croup

A

barking cough

hoarse voice

100
Q

cause of croup

A

viral

parainflu, adeno, RSV, rhino

101
Q

x-ray of croup

A

steeple sign

narrowing of subglottic region

102
Q

tx for croup

A

supportive b/c its viral

cool-mist therapy
corticosteroids

103
Q

hot potato voice

A

epiglottitis

h. influ

104
Q

x-ray of epiglottitis

A

thumb sign

105
Q

signs and sx

IBS

A

constipatio
diarrhea
ALTERNATING

with periods of normal bowel habits

106
Q

how to diagnose

IBS

A

Rome criteria
cumulative total of 12 weeks of this:

abdominal pain/discomfort, PLUS
relieved with BM
change in freq BMs (more or less)
change in stool appearance

107
Q

IBS

alarm features

A 
fever
anemia
wt loss > 10 lb
hematochezia (BRBPR)
melena
refractory/bloody diarrhea
fam hx of colon cx or Inflamm Bowel Dis
108
Q

IBS

no alarm features, whats the workup then

A

CBC
stool hemoccult

colo if > 50yo

109
Q

tx for IBS

A

antaispasmodics - dicyclomine / hyoscyamine
TCA’s / SSRIs
tegaserod (5HT serotonin) - constipation

110
Q

CAGE questions

A

cut drinking
annoyed
guilty
eye opener

111
Q

at-risk drinking

A

men < 65
more than 4 drinks / day
more than 14 in a week

men > 65 and ALL women
more than 3 drinks per day
more than 7 in a week

112
Q

how effective are antidepressants in alcoholics?

A

if depression came at same time as alcoholism, then antidepressants have NO EFFECT

113
Q

signs and sx

alcohol withdrawal

A 
shake/jitters
insomnia
anxiety
depressed mood
heart palpitations

severe sx:
seizures
hallucinations
DTs (agitation/tremors)

114
Q

tx for alcohol withdrawal

A

benzodiazpines

115
Q

complications of long QT syndrome

A

ventricular arrhythmias
sudden cardiac death
(more in females)

116
Q

how long should long QT syndrome be

A

470 msec

if over 500 msec, major problemos

117
Q

features

Marfans

A 
scoliosis
pectus excavatum
arachnodactyly
high arched palate
arm span greater than height
mitral valve prolapse
aortic aneurysm rupture
118
Q

tx for SVTs

A

carotid sinus massage
valsalva maneuver
cold applications to face

adenosine

119
Q

tx for local reactions of insect stings

A

supportive
ice
antihistamine for itching
tetanus prophylaxis if not vaccinated

120
Q

tx for delayed reaction to bee sting

A

oral steroids

tetanus prophylaxis

121
Q

tx for anaphylaxis of bee sting

A

sq or IM epi ASAP
antihistamine
bronchodilators

122
Q

tx for animal bites

A

irrigate and debride it

abx for 3-5 days (amox-clav)
if celllulitis - abx for 7-14 days
hospitalization for more severe

123
Q

thrombolytic therapy should be started within how many hours after onset of stroke

124
Q

waht sign tells you a stroke has affected the dominant hemisphere

A

aphasia

middle cerebral artery

125
Q

what tests to order in a stroke pt

A

head CT noncon

EKG (MI may cause stroke)

126
Q

goal BP for stroke

127
Q

how to prevent another stroke

A

stop smoking
drinks less

treat HLD
antiplatelets (aspirin)

128
Q

signs and sx following initial exposure to HIV

6-8 weeks following exposure

A

low-grade fever
fatigue
myalgias

129
Q

why do you get the symptoms of HIV?

A

seroconversion

development of antibodies to virus

130
Q

lab definition of AIDS

A

CD4 < 200

any AIDS defining illness

131
Q

prophylaxis for what when CD4 dips below 200

A

pneumocystis

bactrim

132
Q

prophylaxis for what when CD4 dips below 50

A

MAI

azithromycin

133
Q

in hyperbilirubinemia, what urinarlysis results do you get

A

elevated bilirubin in CONJUGATED because it gets excreted in urine

unconjugated is not excreted

134
Q

what is gilbert syndrome

A

unconjugated hyperbilirubinemia

135
Q

marker for hepatitis contagiousness

A

surface antigen

136
Q

markers for acute viral hepatitis

A

IgM to core antigen

surface antigen

137
Q

definition of chronic viral hepatitis

A

surface antigen

but no IgM to core antigen

138
Q

lab findings in alcohol abuse

A

AST&raquo_space;» ALT

200 : 1

139
Q

how do you test for h pylori

A

urea breath test
stool antigen test
serum antibodies

140
Q

in a patient with new onset dyspepsia, when should you do an upper gi endoscopy

A 
wt loss
progressive dysphagia
recurrent vomiting
GI bleed
FAMILY HX OF CANCER
141
Q

risk factors for PUD

A

h pylori
NSAID
smoking
personal/family hx of PUD

142
Q

in a pt over than 50 who has PUD or melena, what else should you do besides upper endoscopy

A

colonoscopy

r/o cancer

143
Q

signs and sx

roseola

A

fever comes then goes

then rash: trunk –> arms

144
Q

waht causes roseola

145
Q

tx for roseola

A

nothing

limited

146
Q

dewdrops on a petal

A

chickenpox

147
Q

diagnosis for chickenpox

A

tzanck smear

148
Q

tx for chickenpox

A

acyclovir

valacyclovir

149
Q

complication of parvovirus B19 in pregnancy

A

fetal hydrops

abortion

150
Q

describe skin findings of neisseria meningitis

A

erythematous maculopapular

then becomes petechiae

151
Q

describe skin findings on rocky mountain spotted fever

A

maculopapular rash starts on WRISTS and ANKLES

Family Medicine (6 decks)

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