FM cases 3 Flashcards
1
Q
A primary relative with an MI under what age is an increased risk for an MI?
A
Myocardial infarction (MI) at a young age (male <55; female <65) in a first-degree relative does increase an individual’s risk for CAD.
2
Q
What is the role of low HbA1cs in the prevention of ACS?
A
Not significant past 7ish
3
Q
What is the role of rapid weight loss in the prevention of ACS?
A
Rapid weight loss increases risk, while normal, slower weight loss improves
4
Q
True or false: adding a beta blocker to a pt who had an MI is advisable, even if their BP is normal
A
True
5
Q
When is a daily ASA indicated?
A
- in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding,
- Adults aged 60 to 69 years with a ≥10% 10-year CVD risk:
6
Q
Which is more likely to produce CHF, ischemic or nonischemic cardiomyopathy?
A
Ischemic
7
Q
a very large S wave in V3 is strongly suggestive of what?
A
LVH
8
Q
True or false: new onset CHF should always go to the ER
A
True, for the most part
9
Q
What is the most common cause of diastolic heart dysfunction?
A
Untreated HTN
10
Q
What are grades A-D of the ACCR/AHA stages of heart failure?
A
A = at risk, but without changes B = Structural heart disease, but no s/sx of HF C = Structural heart disease with prior or current symptoms of HF D = Refractory HF requiring specialized interventions
11
Q
When is digoxin indicated?
A
Grade C or NYHA classes II and further
12
Q
True or false: there is no difference between the benefits of ACEIs vs ARBs in terms of HF outcomes
A
True
13
Q
What is the role of Beta blockers in the treatment of HF?
A
Improves outcomes in the long term, but should be titrated up very slowly
14
Q
What is the role of CCBs in the treatment of chronic HF?
A
Calcium channel blockers do not have a major role in the management of heart failure. Amlodipine (B) has been demonstrated to increase peripheral edema and therefore may be avoided.
15
Q
Which DM drugs worsen HF?
A
Thiazolidinediones such as rosiglitazone (Avandia) and pioglitazone (Actos) (G) have been demonstrated to worsen heart failure. They are contraindicated in this setting
16
Q
What is the role of eplerenone in the treatment of HF?
A
Eplerenone reduced both the risk of death and the risk of hospitalization among patients with systolic heart failure whose ejection fraction was no more than 35% and who had mild symptoms
17
Q
What are the stress tests to use in a pt with moderate pretest probability of heart disease?
A
Treadmill stress test
Nuclear
Stress echo
18
Q
What are the two major risk factors for the development of primary dysmenorrhea?
A
Depression/anxiety
Smoking
19
Q
True or false: primary dysmenorrhea is associated with a lower socioeconomic class
A
False
20
Q
When do the symptoms of primary dysmenorrhea occur? How long do they typically last?
A
a day prior to the onset of menses, and last up to 72 hours.
21
Q
Unless a woman is pregnant, a normal uterus in not larger than (___) weeks in size
A
Eight
22
Q
True or false: Nabothian cysts are normal on pevlic exam
A
True
23
Q
What is the normal periodicity of menstruation?
A
21 to 35 days
24
Q
Anything longer than (___) days is most likely menorrhagia.
A
Seven
25
What is metrorrhagia?
Irregular, frequent bleeding but it doesn't have to be heavy.
26
What is menorrhagia?
Excessive bleeding
27
What is menometrorrhagia?
Irregular frequent and heavy bleeding.
28
What are the symptoms/clinical criteria to diagnose premenstrual dysphoric disorder?
5 of the following:
- Mood lability
- irritability/anger
- Depressed mood
- Anxiety and edginess
- Food craving
- Changes in sleep
- Anhedonia
- Fatigue
- physical symptoms
29
What is adenomyosis? What are the usual s/sx?
a gynecologic medical condition characterized by the abnormal presence of endometrial tissue (the inner lining of the uterus) within the myometrium
Chronic pelvic pain, menorrhagia, menometrorrhagia, dyspareunia
Enlarged, symmetric uterus
30
When should von Willebrand testing be done in a pt with menorrhagia?
Only if under 15 years, and even then debateable
31
What type of contraception is recommended for the treatment of fibroids in a woman who wants to maintain fertility?
progesterone-releasing IUD
OCPs
DEPO
32
What are the three drugs that can be used to treat premenstrual dysphoric disorder?
- Danazol
- OCPs
- SSRIs
33
What is the MOA and use of danazol?
androgenic medication with progesterone effects. It lowers estrogen and inhibits ovulation
34
What is the best treatment for premenstrual syndrome?
Continuous SSRIs
35
What are the "dizzy" symptoms associated with aminoglycoside toxicity?
Vertigo and hearing loss
36
What is vestibular neuritis (labyrinthitis)?
Vertigo 2/2 inflammation of the middle ear, usually after a URI.
37
What are the major differences in the characteristics of the nystagmus in central vs peripheral causes?
- Peripheral is unidirectional, and does not change directions
- Peripheral can be inhibited with focused gaze
- onset lag with peripheral
38
What is the difference between acute labyrinthitis and vestibular neuritis?
- Acute labyrinthitis occurs when an infection affects both branches of the nerve resulting in tinnitus and/or hearing loss as well as vertigo.
39
What is the head thrust test that is used to differentiate between peripheral and central causes of vertigo?
Normally, when you face your patient and ask them to keep looking at your nose, his eyes will stay fixed on your nose if you move his head suddenly to the side. If there is a peripheral lesion in the vestibular system, the vestibular ocular reflex will be disrupted and his eyes will move with the head and then saccade back to center when his head is moved in the direction of the lesion. A normal head thrust test in the presence of vertigo means the peripheral vestibular system is intact and that the lesion is central.
40
Which is able to be inhibited with visual fixation: central or peripheral causes of nystagmus
Peripheral
41
Which type of nystagmus changes direction: central or peripheral lesions?
Central can change directions
42
What are the three major risks of a mother under the age of 20 having a child?
- Increased risk for lower birth weight 2/2 HTN
- Poorer developmental outcomes
- Increased chances for infection of baby
43
What are the distinctive effects of marijuana on fetuses?
No distinct features
44
When can small for gestational age be diagnosed, as opposed to intrauterine growth restriction?
```
SGA = at birth
IUGR = in utero
```
45
True or false: delivery after 37 weeks' gestation is a risk factor for transmitting HIV to the fetus
False
46
Gestations of less than how many weeks is an indication for GBS treatment?
Less than 37
47
Membranes that have been ruptured for longer than how many hours is an indication to prophylax against GBS?
18 hours
48
True or false: a previous infant with GBS disease is an indication to prophylax against GBS
true
49
True or false: GBS bacteriuria during any trimester of the current pregnancy is an indication for treatment of GBS
True
50
A temperature of over how much is considered an indication for GBS treatment?
Over 100.4 F
51
What is the difference between symmetric and asymmetric growth restriction?
Symmetric IUGR refers to a growth pattern in which head, length, and weight are decreased proportionately.
Asymmetric IUGR refers to a greater decrease in the size of the length and/or weight without affecting head circumference ("head-sparing phenomenon").
52
What are three major risks for SGA newborns?
Hypoglycemia
Hypothermia
Polycythemia
53
What is the etiology and symptoms of hypoglycemia in a SGA infant?
Decreased glycogen stores and gluconeogenesis
Commonly asymptomatic, though may exhibit poor feeding and listlessness
54
What is the etiology and symptoms of hypothermia in a SGA infant?
Hypoxia, increased surfaces area
Commonly asymptomatic, though may exhibit poor feeding and listlessness
55
What is the etiology and symptoms of polycythemia in a SGA infant?
Chronic hypoxia
"Ruddy" or red color to skin
Respiratory distress*
Poor feeding
56
True or false: microcephaly is a possible consequence of maternal stimulant use
False
57
How are rubella, toxo, and CMV diagnosed in a neonate?
IgM titers for rubella and toxo
Urine culture for CMV (or PCR)
58
When can HBIG be given to neonates after diagnosis of maternal Hep B is confirmed?
Effective if given within 7 days
59
Erythromycin eye drops are routinely given to newborns to prevent what infection?
Gonococcal conjunctivitis
60
What are the common neurological findings of congenital CMV infections?
Lissencephaly
| Sensorineural hearing loss
61
What is the treatment for congenital CMV infection?
Ganciclovir x 6 months
62
How often do neonates feed?
8-12 times /day
63
What is the recommended breastfeeding age?
Exclusive breastfeeding is recommended for the first 6 months of life, followed by breastfeeding plus complementary foods until the infant is at least 12 months of age.
64
True or false: there is a wide spectrum of disease with congenital CMV infections
True
65
What are the three common skin findings associated with CMV?
Petechiae
Purpura
Jaundice
66
What are the hepatobiliary findings associated with congenital CMV?
Elevated LFTs
Hepatomegaly
Hyperbilirubinemia
67
What eye finding is common to congenital CMV?
Chorioretinitis
68
A 19-year-old female in her 38th week of pregnancy goes into active labor. Shortly after birth her baby is noted to have a high-pitched cry, tremulousness, hypertonicity, and feeding difficulties. The baby is otherwise developmentally normal and the remainder of the physical exam also is normal. What is the drug the baby's mother likely used during her pregnancy?
Heroin
69
What are the five criteria that are used to diagnose metabolic syndrome (only need 3)?
- Fasting plasma glucose > 100 mg/dL (or on medical therapy for hyperglycemia)
- BP ≥ 130/85 mmHg (or on medical therapy for hypertension)
- Triglycerides ≥ 150 mg/dL (or on medical therapy for hypertriglyceridemia)
- High density lipoprotein (HDL) cholesterol < 40 mg/dL for men, < 50 mg/dL for women (or on medical therapy for low HDL cholesterol)
- Abdominal obesity (waist circumference > 40" for men, > 35" for women)
70
What are the 5 A's of behavioral counseling?
- Assess the patient's dietary practices and related risk factors.
- Advise the patient to change dietary practices.
- Agree with the patient on goals.
- Assist the patient in changing dietary practices or addressing motivational barriers.
- Arrange follow-up, support, and/or referral for the patient.
71
Patients with untreated LDL cholesterol greater than or equal to (___) should be evaluated for secondary causes of their dyslipidemia
190
72
What causes Familial combined hyperlipidemia? Treatment?
- Elevated apolipoprotein B causes elevated LDL, triglycerides,
- Nicotinic acid
73
What causes Dysbetalipoproteinemia? Treatment?
Decreased ability to convert very low-density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) to low-density lipoprotein (LDL) particles in the blood
Statins or fibrates
74
What is the pharmacotherapy for reducing triglycerides?
Fibrates
75
What are the three types of pts that should receive high statin therapy?
- patients > 75 years of age with clinical ASCVD
- those with LDL cholesterol > 190 mg/dL
- diabetics aged 40-75 with estimated 10-year ASCVD risk of > 7.5%
76
Moderate intensity therapy is recommended for, what three types of pts?
- patients < 75 years of age with clinical ACSVD
- diabetics aged 40-75 with estimated 10-year ASCVD risk of < 7.5%
- patients for whom high-dose therapy would be recommended but who are not candidates for high-intensity statins.
77
True or false: cutting out etoh reduces cholesterol levels
False
78
How many calories are in a pound of fat?
3500
79
What are the four major appetite suppressant drugs used to control weight?
Phentermine
Diethylpropion
Phendimetrazine
Benzphetamine
80
What is the most common cause of syncope in pts with dilated cardiomyopathy?
Ventricular arrhythmia
81
What endocrine abnormality should be evaluated in the setting of extremely elevated cholesterol levels?
Hypothyroidism
82
Why should H2O2 be avoided in pts who have a TM occluded by cerumen?
If TM ruptured, will worsen
83
What happens to complement levels in PSGN and IgA nephropathy respectively?
```
PSGN = decreased
IgA = normal
```
84
What is the major adverse effect associated with gene therapy for SCID?
Leukemia
85
What is the drug that is used to prevent renal injury prior to contrast CT?
acetylcysteine
86
What is gene therapy?
Transduction of a missing gene into a retrovirus to replace a missing gene in pts
87
What is the pathophysiology of osteitis fibrosa cystica?
Increased phosphate (retention from renal failure or PTH adenoma) leads to increase in PTH, leaching of Ca, from bone and bone weakening
88
What is the classic CXR finding associated with osteitis fibrosa cystica?
"Rugby jersey" spine
89
What happens to end-diastolic volume of the heart with diastolic dysfunction?
normal or near normal
90
How do carcinoid tumors lead to restrictive cardiomyopathy?
Deposition of plaque like tissue on the lining of the heart
91
What is the treatment for a low energy, non-displaced pubic ramus fracture?
Pain management and activity as tolerated
92
Most babies lose a little weight right after birth, then may regain their birth weight as early as 1 week of age, but are definitely expected to have regained their birth weight by what age?
2 weeks
93
What is the daily caloric intake for term infants between 1-2 months of age? Preterm? VLBW?
```
Term = 100 calories/kg
Preterm = 125 cal/kg
VLBW = 150 cal/kg
```
94
What is the moro reflex, and how long will babies exhibit this? What is the use of this?
- Dropping baby and it reaches out
- Until 4 months
- Used to detect peripheral MS or neurological problems
95
How long do babies exhibit the palmar grasp reflex?
2-3 months
96
How long do babies exhibit the plantar grasp reflex?
until 8 months
97
When does the fencer's reflex disappear?
6 months
98
When does the babinski test become downgoing in an infant?
Between 1-2 years
99
What are the four major domains that a physician assesses at a well child check?
Gross motor
Fine motor
Communicative/social
Cognitive/adaptive
100
FOr what ages it he parent's evaluation of developmental status (PEDS) screening tool used?
0-8 years
101
When can solid foods begin to be introduced into an infant's diet?
4 months
102
What is the recommended vit D intake for infants?
400 units /day
103
When do babies begin to sleep fully through the night?
Between 4-6 months
104
How should a baby sleep to prevent SIDs?
Placed on back to sleep
105
Until what age should children be rear facing in the car?
2 years
106
Which seat in a car is the safest for a child?
Middle Back seat
107
What is the appropriate restraining device for a 2-4 year old in a car?
Forward facing car safety seat
108
What is the appropriate restraining device for a 4-8 year old in a car?
Belt positioning booster seat
109
When can a kid no longer use a booster seat and sit in the front?
8 years
110
When is the first DTaP given?
2 months
111
By what ages should an infant double and triple his or her birth weight?
Double by 5 months, triple by 12 months
112
When should a child be able to roll over?
6 months
113
When should a child be able to sit unsupported?
6 months
114
When should a child be able to reach for objects and look for dropped items?
6 months
115
When should a child turn their head towards a voice
6 months
116
When should a child be able to feed themselves?
6 months
117
When does stranger recognition begin?>
6 months
118
When should a child begin babbling?
6 months
119
What is the role of walkers for infants?
The AAP has recommended against the use of walkers because of the risk of injury, especially when there are stairs in the home. In addition, walkers do not teach children to walk any earlier than they otherwise would.
120
How many naps per day can be expected for a 6 month old?
2
121
Why should acetaminophen be avoided in children with pain 2/2 immunizations?
Lowers immune response
122
When can meats be started in a child?
9 months
123
How often should new foods be introduced into an infant's diet? Why?
Every 5-7 days to identify allergies
124
When can an infant begin to stand?
9 months, but up to 12
125
When should an infant have a well developed pincer grasp?
12 months
126
When should an infant be able to say mama, dada, and 1-2 other words?
12 months
127
When should an infant begin to wave bye bye?
9 months
128
What is the most frequently diagnosed neoplasm in infants under 2 years?
Neuroblastoma
129
Which side is constipation usually felt on abdominal exam?
Left side
130
What are the urine findings of a neuroblastoma?
Elevated levels of Urine vanillylmandelic acid (VMA) and urine homovanillic acid (HVA)
131
What are the histological findings of a neuroblastoma?
Small round blue cells with scant cytoplasm
132
What is a neuroblastoma?
neuroendocrine tumor of the adrenal gland
133
What is the only major lab abnormality of a Wilms tumor?
Hematuria
134
When do most infants begin to run?
18 months
135
When should an infant be able to stack 2 cubes?
18 months
136
When should an infant be able to remove garments be themselves?
18 months
137
What tumor is associated with Beckwith-wiedemann syndrome?
Wilms tumor
138
When should a child be able to walk backwards?
18 months
139
When should a child be able to: balance on 1 foot
3 years
140
When should a child be able to: name 4 pictures
3 years
141
When should a child be able to: name 1 color
3 years
142
When should a child be able to: name a friend
3 years
143
When should a child be able to: brush their teeth with help
3 years
144
When should a child be able to: build a tower of 6-8 cubes
2.5 years
145
When should a child be able to: point to 6 body parts
2.5 years
146
When should a child be able to: put on clothing
2.5 years
147
When should a child be able to: wash and dry their hands
2.5 years
148
True or false: in neuroblastoma, non-amplification of the n-myc gene is favorable for prognosis
true
149
What are the three shots that are received at 9 months?
Flu
Hep B
IPV
150
What are the histological characteristics of Burkitt's lymphoma?
Sheets of lymphocytes with interspersed macrophages "Starry sky"
151
What is the screening tool used to screen for autism?
M-CHAT
152
When is vision screening with a chart started in kids? What is done to screen for vision before this?
3 years
| Before this, just asking mother about any concerns
153
Hearing evaluation through audiometry begins at what age?
4 years
154
When should children start seeing a dentist?
At tooth eruption or by 1 age.
155
When is a child expected to: speak in 2-3 word sentences?
3 years old
156
When is a child expected to: know age and gender
4 years
157
When is a child expected to: be friendly with other children
4 years
158
When is a child expected to: engage in fantasy play
4 years
159
When is a child expected to: listen and be attentive
5 years
160
When is a child expected to: tell the difference between real and make-believe
5 years
161
When is a child expected to: show sympathy for others
5 years
162
When is a child expected to: state first and last name
4 years
163
When is a child expected to: sing a song
4 years
164
When is a child expected to: be clearly understandable nearly 100% of the time
4 years
165
When is a child expected to: tell a simple story
4 years
166
When is a child expected to: count to 10
5 years
167
When is a child expected to: follow simple directions
5 years
168
When is a child expected to: know names of simple objects?
3 years
169
When is a child expected to: name colors
4 years
170
When is a child expected to: play board games
4 years
171
When is a child expected to: copy a cross
4 years
172
When is a child expected to: copy a circle
3 years
173
When is a child expected to: build a tower of 6-8 cubes?
3 years
174
When is a child expected to: throw a ball overhand
3 years
175
When is a child expected to: brush teeth
3 years
176
When is a child expected to: balance for 2 seconds?
4 years
177
When is a child expected to: hop on one foot
4 years
178
When is a child expected to: balance on one foot
5 years
179
When is a child expected to: tie a knot
5 years
180
When is a child expected to: have a mature pencil grasp
5 years
181
When is a child expected to: undress/dress with minimal assistance
5 years
182
What is the "itch that rashes", and usually is located in the antecubital fossa?
Eczema
183
True or falseL psoriasis is rare in children
True
184
What usually precedes psoriasis in children?
Strep infection
185
What is the treatment for eczema? (3)
Lubricating lotions
Anti-inflammatories (rx steroids) in short bursts
Treating associated skin infections aggressively
186
What is the first and second line pharmacotherapy for eczema?
- Topical steroids
| - Calcineurin inhibitors
187
What is the best way to toilet train?
No punishment, just rewards for doing well.
| Modeling
188
When should bottle feeding be stopped?
12-15 months
189
What is intoeing, and what is the natural history of it?
When patella is facing forward, but toes point inward.
| Self resolves by 4 years
190
What is femoral anteversion, and what is the natural history of it?
In femoral anteversion both the feet and knees turn inward. Femoral anteversion usually resolves spontaneously by 8-12 years of age.
191
When is fingerstick Hb levels obtained during a well child exam?
If risk for anemia or at 12 months
192
True or false: a person has an increased risk for the development of breast cancer only if it is in a first degree relative
True
193
True or false: The USPSTF does not recommend self breast exams
True
194
How often should women have clinical breast exams?
q3 years between 20-40
| Yearly for 40+
195
True or false: smoking increases the risk for cervical cancer
True
196
When does cervical cancer screening begin? How often (changes for ages)?
At 21 years old q3 years until 30
| 30-65, q5 years if with HPV testing, o/w q3 years
197
True or false:Women who have undergone a total hysterectomy for any reason do not require cervical cancer screening.
false--Women who have undergone a total hysterectomy for *benign* reasons do not require cervical cancer screening.
198
When are low dose CTs recommended for lung cancer screening (ages, pack years)?
55-80 years old who have smoked for 30 pack years.
199
What is the USPSTF recommendation for mammographies?
Biennial screening mammography for women aged 50-74 years
200
A breast mass over how many centimeters is concerning for CA?
2 cm
201
Prolonged exposure to estrogen, including menarche before age (__) or menopause after age (__) is a risk for breast cancer.
12
| 45
202
True or false: both Etoh and smoking increase the risk for breast cancer
False- etoh does, smoking has not been shown
203
Only after a woman has not menstruated for (__) straight months can menopause be confirmed.
12
204
For bone health, it is recommended that pre menopausal women need approximately (___) mg
of calcium daily while post menopausal women need (___) mg of calcium daily.
For bone health, it is recommended that pre menopausal women need approximately 1000 mg
of calcium daily while post menopausal women need 1200 mg of calcium daily.
205
What is the effect of obesity on osteoporosis?
Decreases risk d/t higher weight bearing and increased estrogen
206
What is the effect of cigarette smoking on the risk of osteoporosis?
Increases chances
207
What are the recommendations for exercise amounts ?
150 minutes of moderate-intensity exercise, 75
| minutes of vigorous intensity exercise, or a combination of both per week
208
What does it mean when a pap smear returns with: Atypical squamous cells (ASC)
Some abnormal cells are seen. These cells may be caused
| by an infection or irritation or may be precancerous.
209
What does it mean when a pap smear returns with: Low-grade squamous intraepithelial lesion (LSIL)
LSIL may progress to a high-grade lesion
| but most regress.
210
What does it mean when a pap smear returns with: High-grade squamous intraepithelial lesion (HSIL)
This is considered a significant
| precancerous lesion
211
What are the strains of HPV that cause cervical cancer?
16, 18
212
What are the strains of HPV that cause warts
6, 11
