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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.

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2
Q

What is the role of low HbA1cs in the prevention of ACS?

A

Not significant past 7ish

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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

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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

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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:
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6
Q

Which is more likely to produce CHF, ischemic or nonischemic cardiomyopathy?

A

Ischemic

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7
Q

a very large S wave in V3 is strongly suggestive of what?

A

LVH

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8
Q

True or false: new onset CHF should always go to the ER

A

True, for the most part

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9
Q

What is the most common cause of diastolic heart dysfunction?

A

Untreated HTN

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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
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11
Q

When is digoxin indicated?

A

Grade C or NYHA classes II and further

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12
Q

True or false: there is no difference between the benefits of ACEIs vs ARBs in terms of HF outcomes

A

True

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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

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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.

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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

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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

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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

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18
Q

What are the two major risk factors for the development of primary dysmenorrhea?

A

Depression/anxiety

Smoking

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19
Q

True or false: primary dysmenorrhea is associated with a lower socioeconomic class

A

False

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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.

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21
Q

Unless a woman is pregnant, a normal uterus in not larger than (___) weeks in size

A

Eight

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22
Q

True or false: Nabothian cysts are normal on pevlic exam

A

True

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23
Q

What is the normal periodicity of menstruation?

A

21 to 35 days

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24
Q

Anything longer than (___) days is most likely menorrhagia.

A

Seven

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25
Q

What is metrorrhagia?

A

Irregular, frequent bleeding but it doesn’t have to be heavy.

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26
Q

What is menorrhagia?

A

Excessive bleeding

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27
Q

What is menometrorrhagia?

A

Irregular frequent and heavy bleeding.

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28
Q

What are the symptoms/clinical criteria to diagnose premenstrual dysphoric disorder?

A

5 of the following:

  • Mood lability
  • irritability/anger
  • Depressed mood
  • Anxiety and edginess
  • Food craving
  • Changes in sleep
  • Anhedonia
  • Fatigue
  • physical symptoms
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29
Q

What is adenomyosis? What are the usual s/sx?

A

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

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30
Q

When should von Willebrand testing be done in a pt with menorrhagia?

A

Only if under 15 years, and even then debateable

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31
Q

What type of contraception is recommended for the treatment of fibroids in a woman who wants to maintain fertility?

A

progesterone-releasing IUD
OCPs
DEPO

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32
Q

What are the three drugs that can be used to treat premenstrual dysphoric disorder?

A
  • Danazol
  • OCPs
  • SSRIs
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33
Q

What is the MOA and use of danazol?

A

androgenic medication with progesterone effects. It lowers estrogen and inhibits ovulation

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34
Q

What is the best treatment for premenstrual syndrome?

A

Continuous SSRIs

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35
Q

What are the “dizzy” symptoms associated with aminoglycoside toxicity?

A

Vertigo and hearing loss

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36
Q

What is vestibular neuritis (labyrinthitis)?

A

Vertigo 2/2 inflammation of the middle ear, usually after a URI.

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37
Q

What are the major differences in the characteristics of the nystagmus in central vs peripheral causes?

A
  • Peripheral is unidirectional, and does not change directions
  • Peripheral can be inhibited with focused gaze
  • onset lag with peripheral
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38
Q

What is the difference between acute labyrinthitis and vestibular neuritis?

A
  • Acute labyrinthitis occurs when an infection affects both branches of the nerve resulting in tinnitus and/or hearing loss as well as vertigo.
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39
Q

What is the head thrust test that is used to differentiate between peripheral and central causes of vertigo?

A

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.

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40
Q

Which is able to be inhibited with visual fixation: central or peripheral causes of nystagmus

A

Peripheral

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41
Q

Which type of nystagmus changes direction: central or peripheral lesions?

A

Central can change directions

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42
Q

What are the three major risks of a mother under the age of 20 having a child?

A
  • Increased risk for lower birth weight 2/2 HTN
  • Poorer developmental outcomes
  • Increased chances for infection of baby
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43
Q

What are the distinctive effects of marijuana on fetuses?

A

No distinct features

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44
Q

When can small for gestational age be diagnosed, as opposed to intrauterine growth restriction?

A 
SGA = at birth
IUGR = in utero
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45
Q

True or false: delivery after 37 weeks’ gestation is a risk factor for transmitting HIV to the fetus

A

False

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46
Q

Gestations of less than how many weeks is an indication for GBS treatment?

A

Less than 37

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47
Q

Membranes that have been ruptured for longer than how many hours is an indication to prophylax against GBS?

A

18 hours

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48
Q

True or false: a previous infant with GBS disease is an indication to prophylax against GBS

A

true

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49
Q

True or false: GBS bacteriuria during any trimester of the current pregnancy is an indication for treatment of GBS

A

True

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50
Q

A temperature of over how much is considered an indication for GBS treatment?

A

Over 100.4 F

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51
Q

What is the difference between symmetric and asymmetric growth restriction?

A

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”).

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52
Q

What are three major risks for SGA newborns?

A

Hypoglycemia
Hypothermia
Polycythemia

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53
Q

What is the etiology and symptoms of hypoglycemia in a SGA infant?

A

Decreased glycogen stores and gluconeogenesis

Commonly asymptomatic, though may exhibit poor feeding and listlessness

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54
Q

What is the etiology and symptoms of hypothermia in a SGA infant?

A

Hypoxia, increased surfaces area

Commonly asymptomatic, though may exhibit poor feeding and listlessness

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55
Q

What is the etiology and symptoms of polycythemia in a SGA infant?

A

Chronic hypoxia

“Ruddy” or red color to skin
Respiratory distress*
Poor feeding

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56
Q

True or false: microcephaly is a possible consequence of maternal stimulant use

A

False

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57
Q

How are rubella, toxo, and CMV diagnosed in a neonate?

A

IgM titers for rubella and toxo

Urine culture for CMV (or PCR)

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58
Q

When can HBIG be given to neonates after diagnosis of maternal Hep B is confirmed?

A

Effective if given within 7 days

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59
Q

Erythromycin eye drops are routinely given to newborns to prevent what infection?

A

Gonococcal conjunctivitis

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60
Q

What are the common neurological findings of congenital CMV infections?

A

Lissencephaly

Sensorineural hearing loss

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61
Q

What is the treatment for congenital CMV infection?

A

Ganciclovir x 6 months

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62
Q

How often do neonates feed?

A

8-12 times /day

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63
Q

What is the recommended breastfeeding age?

A

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.

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64
Q

True or false: there is a wide spectrum of disease with congenital CMV infections

A

True

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65
Q

What are the three common skin findings associated with CMV?

A

Petechiae
Purpura
Jaundice

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66
Q

What are the hepatobiliary findings associated with congenital CMV?

A

Elevated LFTs
Hepatomegaly
Hyperbilirubinemia

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67
Q

What eye finding is common to congenital CMV?

A

Chorioretinitis

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68
Q

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?

A

Heroin

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69
Q

What are the five criteria that are used to diagnose metabolic syndrome (only need 3)?

A
  • 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)
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70
Q

What are the 5 A’s of behavioral counseling?

A
  • 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.
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71
Q

Patients with untreated LDL cholesterol greater than or equal to (___) should be evaluated for secondary causes of their dyslipidemia

A

190

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72
Q

What causes Familial combined hyperlipidemia? Treatment?

A
  • Elevated apolipoprotein B causes elevated LDL, triglycerides,
  • Nicotinic acid
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73
Q

What causes Dysbetalipoproteinemia? Treatment?

A

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

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74
Q

What is the pharmacotherapy for reducing triglycerides?

A

Fibrates

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75
Q

What are the three types of pts that should receive high statin therapy?

A
  • 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%
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76
Q

Moderate intensity therapy is recommended for, what three types of pts?

A
  • 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.
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77
Q

True or false: cutting out etoh reduces cholesterol levels

A

False

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78
Q

How many calories are in a pound of fat?

A

3500

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79
Q

What are the four major appetite suppressant drugs used to control weight?

A

Phentermine
Diethylpropion
Phendimetrazine
Benzphetamine

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80
Q

What is the most common cause of syncope in pts with dilated cardiomyopathy?

A

Ventricular arrhythmia

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81
Q

What endocrine abnormality should be evaluated in the setting of extremely elevated cholesterol levels?

A

Hypothyroidism

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82
Q

Why should H2O2 be avoided in pts who have a TM occluded by cerumen?

A

If TM ruptured, will worsen

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83
Q

What happens to complement levels in PSGN and IgA nephropathy respectively?

A 
PSGN = decreased
IgA = normal
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84
Q

What is the major adverse effect associated with gene therapy for SCID?

A

Leukemia

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85
Q

What is the drug that is used to prevent renal injury prior to contrast CT?

A

acetylcysteine

86
Q

What is gene therapy?

A

Transduction of a missing gene into a retrovirus to replace a missing gene in pts

87
Q

What is the pathophysiology of osteitis fibrosa cystica?

A

Increased phosphate (retention from renal failure or PTH adenoma) leads to increase in PTH, leaching of Ca, from bone and bone weakening

88
Q

What is the classic CXR finding associated with osteitis fibrosa cystica?

A

“Rugby jersey” spine

89
Q

What happens to end-diastolic volume of the heart with diastolic dysfunction?

A

normal or near normal

90
Q

How do carcinoid tumors lead to restrictive cardiomyopathy?

A

Deposition of plaque like tissue on the lining of the heart

91
Q

What is the treatment for a low energy, non-displaced pubic ramus fracture?

A

Pain management and activity as tolerated

92
Q

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?

A

2 weeks

93
Q

What is the daily caloric intake for term infants between 1-2 months of age? Preterm? VLBW?

A 
Term = 100 calories/kg
Preterm = 125 cal/kg
VLBW = 150 cal/kg
94
Q

What is the moro reflex, and how long will babies exhibit this? What is the use of this?

A
  • Dropping baby and it reaches out
  • Until 4 months
  • Used to detect peripheral MS or neurological problems
95
Q

How long do babies exhibit the palmar grasp reflex?

A

2-3 months

96
Q

How long do babies exhibit the plantar grasp reflex?

A

until 8 months

97
Q

When does the fencer’s reflex disappear?

A

6 months

98
Q

When does the babinski test become downgoing in an infant?

A

Between 1-2 years

99
Q

What are the four major domains that a physician assesses at a well child check?

A

Gross motor
Fine motor
Communicative/social
Cognitive/adaptive

100
Q

FOr what ages it he parent’s evaluation of developmental status (PEDS) screening tool used?

A

0-8 years

101
Q

When can solid foods begin to be introduced into an infant’s diet?

A

4 months

102
Q

What is the recommended vit D intake for infants?

A

400 units /day

103
Q

When do babies begin to sleep fully through the night?

A

Between 4-6 months

104
Q

How should a baby sleep to prevent SIDs?

A

Placed on back to sleep

105
Q

Until what age should children be rear facing in the car?

A

2 years

106
Q

Which seat in a car is the safest for a child?

A

Middle Back seat

107
Q

What is the appropriate restraining device for a 2-4 year old in a car?

A

Forward facing car safety seat

108
Q

What is the appropriate restraining device for a 4-8 year old in a car?

A

Belt positioning booster seat

109
Q

When can a kid no longer use a booster seat and sit in the front?

A

8 years

110
Q

When is the first DTaP given?

A

2 months

111
Q

By what ages should an infant double and triple his or her birth weight?

A

Double by 5 months, triple by 12 months

112
Q

When should a child be able to roll over?

A

6 months

113
Q

When should a child be able to sit unsupported?

A

6 months

114
Q

When should a child be able to reach for objects and look for dropped items?

A

6 months

115
Q

When should a child turn their head towards a voice

A

6 months

116
Q

When should a child be able to feed themselves?

A

6 months

117
Q

When does stranger recognition begin?>

A

6 months

118
Q

When should a child begin babbling?

A

6 months

119
Q

What is the role of walkers for infants?

A

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
Q

How many naps per day can be expected for a 6 month old?

A

2

121
Q

Why should acetaminophen be avoided in children with pain 2/2 immunizations?

A

Lowers immune response

122
Q

When can meats be started in a child?

A

9 months

123
Q

How often should new foods be introduced into an infant’s diet? Why?

A

Every 5-7 days to identify allergies

124
Q

When can an infant begin to stand?

A

9 months, but up to 12

125
Q

When should an infant have a well developed pincer grasp?

A

12 months

126
Q

When should an infant be able to say mama, dada, and 1-2 other words?

A

12 months

127
Q

When should an infant begin to wave bye bye?

A

9 months

128
Q

What is the most frequently diagnosed neoplasm in infants under 2 years?

A

Neuroblastoma

129
Q

Which side is constipation usually felt on abdominal exam?

A

Left side

130
Q

What are the urine findings of a neuroblastoma?

A

Elevated levels of Urine vanillylmandelic acid (VMA) and urine homovanillic acid (HVA)

131
Q

What are the histological findings of a neuroblastoma?

A

Small round blue cells with scant cytoplasm

132
Q

What is a neuroblastoma?

A

neuroendocrine tumor of the adrenal gland

133
Q

What is the only major lab abnormality of a Wilms tumor?

A

Hematuria

134
Q

When do most infants begin to run?

A

18 months

135
Q

When should an infant be able to stack 2 cubes?

A

18 months

136
Q

When should an infant be able to remove garments be themselves?

A

18 months

137
Q

What tumor is associated with Beckwith-wiedemann syndrome?

A

Wilms tumor

138
Q

When should a child be able to walk backwards?

A

18 months

139
Q

When should a child be able to: balance on 1 foot

A

3 years

140
Q

When should a child be able to: name 4 pictures

A

3 years

141
Q

When should a child be able to: name 1 color

A

3 years

142
Q

When should a child be able to: name a friend

A

3 years

143
Q

When should a child be able to: brush their teeth with help

A

3 years

144
Q

When should a child be able to: build a tower of 6-8 cubes

A

2.5 years

145
Q

When should a child be able to: point to 6 body parts

A

2.5 years

146
Q

When should a child be able to: put on clothing

A

2.5 years

147
Q

When should a child be able to: wash and dry their hands

A

2.5 years

148
Q

True or false: in neuroblastoma, non-amplification of the n-myc gene is favorable for prognosis

A

true

149
Q

What are the three shots that are received at 9 months?

A

Flu
Hep B
IPV

150
Q

What are the histological characteristics of Burkitt’s lymphoma?

A

Sheets of lymphocytes with interspersed macrophages “Starry sky”

151
Q

What is the screening tool used to screen for autism?

A

M-CHAT

152
Q

When is vision screening with a chart started in kids? What is done to screen for vision before this?

A

3 years

Before this, just asking mother about any concerns

153
Q

Hearing evaluation through audiometry begins at what age?

A

4 years

154
Q

When should children start seeing a dentist?

A

At tooth eruption or by 1 age.

155
Q

When is a child expected to: speak in 2-3 word sentences?

A

3 years old

156
Q

When is a child expected to: know age and gender

A

4 years

157
Q

When is a child expected to: be friendly with other children

A

4 years

158
Q

When is a child expected to: engage in fantasy play

A

4 years

159
Q

When is a child expected to: listen and be attentive

A

5 years

160
Q

When is a child expected to: tell the difference between real and make-believe

A

5 years

161
Q

When is a child expected to: show sympathy for others

A

5 years

162
Q

When is a child expected to: state first and last name

A

4 years

163
Q

When is a child expected to: sing a song

A

4 years

164
Q

When is a child expected to: be clearly understandable nearly 100% of the time

A

4 years

165
Q

When is a child expected to: tell a simple story

A

4 years

166
Q

When is a child expected to: count to 10

A

5 years

167
Q

When is a child expected to: follow simple directions

A

5 years

168
Q

When is a child expected to: know names of simple objects?

A

3 years

169
Q

When is a child expected to: name colors

A

4 years

170
Q

When is a child expected to: play board games

A

4 years

171
Q

When is a child expected to: copy a cross

A

4 years

172
Q

When is a child expected to: copy a circle

A

3 years

173
Q

When is a child expected to: build a tower of 6-8 cubes?

A

3 years

174
Q

When is a child expected to: throw a ball overhand

A

3 years

175
Q

When is a child expected to: brush teeth

A

3 years

176
Q

When is a child expected to: balance for 2 seconds?

A

4 years

177
Q

When is a child expected to: hop on one foot

A

4 years

178
Q

When is a child expected to: balance on one foot

A

5 years

179
Q

When is a child expected to: tie a knot

A

5 years

180
Q

When is a child expected to: have a mature pencil grasp

A

5 years

181
Q

When is a child expected to: undress/dress with minimal assistance

A

5 years

182
Q

What is the “itch that rashes”, and usually is located in the antecubital fossa?

A

Eczema

183
Q

True or falseL psoriasis is rare in children

A

True

184
Q

What usually precedes psoriasis in children?

A

Strep infection

185
Q

What is the treatment for eczema? (3)

A

Lubricating lotions
Anti-inflammatories (rx steroids) in short bursts
Treating associated skin infections aggressively

186
Q

What is the first and second line pharmacotherapy for eczema?

A
  • Topical steroids

- Calcineurin inhibitors

187
Q

What is the best way to toilet train?

A

No punishment, just rewards for doing well.

Modeling

188
Q

When should bottle feeding be stopped?

A

12-15 months

189
Q

What is intoeing, and what is the natural history of it?

A

When patella is facing forward, but toes point inward.

Self resolves by 4 years

190
Q

What is femoral anteversion, and what is the natural history of it?

A

In femoral anteversion both the feet and knees turn inward. Femoral anteversion usually resolves spontaneously by 8-12 years of age.

191
Q

When is fingerstick Hb levels obtained during a well child exam?

A

If risk for anemia or at 12 months

192
Q

True or false: a person has an increased risk for the development of breast cancer only if it is in a first degree relative

A

True

193
Q

True or false: The USPSTF does not recommend self breast exams

A

True

194
Q

How often should women have clinical breast exams?

A

q3 years between 20-40

Yearly for 40+

195
Q

True or false: smoking increases the risk for cervical cancer

A

True

196
Q

When does cervical cancer screening begin? How often (changes for ages)?

A

At 21 years old q3 years until 30

30-65, q5 years if with HPV testing, o/w q3 years

197
Q

True or false:Women who have undergone a total hysterectomy for any reason do not require cervical cancer screening.

A

false–Women who have undergone a total hysterectomy for benign reasons do not require cervical cancer screening.

198
Q

When are low dose CTs recommended for lung cancer screening (ages, pack years)?

A

55-80 years old who have smoked for 30 pack years.

199
Q

What is the USPSTF recommendation for mammographies?

A

Biennial screening mammography for women aged 50-74 years

200
Q

A breast mass over how many centimeters is concerning for CA?

A

2 cm

201
Q

Prolonged exposure to estrogen, including menarche before age (__) or menopause after age (__) is a risk for breast cancer.

A

12

45

202
Q

True or false: both Etoh and smoking increase the risk for breast cancer

A

False- etoh does, smoking has not been shown

203
Q

Only after a woman has not menstruated for (__) straight months can menopause be confirmed.

A

12

204
Q

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.

A

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
Q

What is the effect of obesity on osteoporosis?

A

Decreases risk d/t higher weight bearing and increased estrogen

206
Q

What is the effect of cigarette smoking on the risk of osteoporosis?

A

Increases chances

207
Q

What are the recommendations for exercise amounts ?

A

150 minutes of moderate-intensity exercise, 75

minutes of vigorous intensity exercise, or a combination of both per week

208
Q

What does it mean when a pap smear returns with: Atypical squamous cells (ASC)

A

Some abnormal cells are seen. These cells may be caused

by an infection or irritation or may be precancerous.

209
Q

What does it mean when a pap smear returns with: Low-grade squamous intraepithelial lesion (LSIL)

A

LSIL may progress to a high-grade lesion

but most regress.

210
Q

What does it mean when a pap smear returns with: High-grade squamous intraepithelial lesion (HSIL)

A

This is considered a significant

precancerous lesion

211
Q

What are the strains of HPV that cause cervical cancer?

A

16, 18

212
Q

What are the strains of HPV that cause warts

A

6, 11

a2 (26 decks)

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