FM cases 4 Flashcards
What is the technical definition of “at risk for being overweight” and “overweight” for children in terms of percentiles?
Risk = 85-95 Overweight = 95 or over
What are the five major red flags for increased risk of learning disability?
- History of maternal illness or substance abuse during pregnancy
- Complications at the time of delivery
- History of meningitis or other serious illness
- History of serious head trauma
- Parental history of learning disabilities or difficulty at school
True or false: stimulant use in children increases the risk for sudden cardiac death
False
True or false: stimulant use increases the risk for substance abuse later on in life
False
True or false: kids taking stimulants may develop tics and/or insomnia
True
True or false: kids who take stimulants for ADHD may experience decreased growth velocity
True
What does the AAP recommend regarding screen time for kids?
No more than 1-2 hours / day, and removing TVs from children’s bedrooms
True or false: a high birth weight is a risk factor for obesity later in life
True
True or false: delayed puberty is a risk factor for obesity later in life
False
What is the link between childhood obesity and breastfeeding?
Lower risk
True or false: a random glucose level over 200 mg/dL alone is diagnostic of DM
False-need s/sx
When should children be screened for DM?
If at risk (BMI over 85th % + s/sx, FHx, or maternal DM) at 10 years, q3 years
What can elevate the BP measurements?
- Taking BP below the level of the heart
- Use of a cuff that is too small
A BP cuff should cover how much of the arm?
2/3 of the upper arm
True or false: guidelines do not recommend searching for secondary causes of HTN in children
True
What perinatal interventions can increase the risk for HTN in the future?
Placement of an umbilical arterial or venous line
How do recurrent UTIs predispose children to HTN?
Cause renal issues, and secondary HTN
Endocrine diseases that cause weight gain in children usually have what other effects?
Limit growth, resulting in short stature
What are the four stages in the stages of change model?
Pre-contemplation
Contemplation
Action
Maintenance
What is the age range that benefits most from daily 81 mg ASA, and is the only group recommended to receive it?
[50-70]
What is the waist circumference measurement in men and women that suggests metabolic syndrome?
Waist circumference (men >102 cm (40 in), women >89 cm (35 in)
What triglyceride level is suggestive of metabolic syndrome?
over 150
What HDL level suggests metabolic syndrome in men and women?
Less than 40 for men
Less than 50 for women
What BP suggests metabolic syndrome?
Over 130/85
What is the fasting glucose level that suggests metabolic syndrome?
over 110 mg/dL
Who is the best pt to receive a stress test?
Those with intermediate probability
What are the three classes of meds that are approved for treating aginal pain?
Beta blockers
CCBs
NTGs
Why is it that stenting high grade coronary artery plaques does not increase survival compared to pts who are only treated medically?
Because the ones that cause stenosis are unlikely to rupture and produce an MI
What is the effect on lipid levels with moderate use of etoh?
Increase HDL slightly
When are zoster vaccines recommended?
Once at age 60
Annual screening for lung cancer with low-dose computed tomography is recommended in adults ages (__) to (__) years who have a (__) pack-year smoking history and currently smoke or have quit within the past (__) years.
Annual screening for lung
cancer with low-dose computed tomography is recommended in adults ages 55 to 80 years who
have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.
Who should be screened for Hep C?
If born between 1945-1965 with risk factors
What is the USPSTF grade for PSA checks?
Grade D
What are the three C’s of addiction?
Compulsion to use
lack of Control
Continued use despite adverse effects
What are the 5 A’s of counseling for behavior change?
Ask / Address Assess interest in changing Advise Assist Arrange f/u
What are the components of the CAGE questionnaire?
felt the need to C ut down your drinking?
felt A nnoyed by criticism of your drinking?
had G uilty feelings about drinking?
taken a morning E ye opener?
What is the schedule for wellbutrin therapy for smoking cessation?
-Start one week before the quit date with one pill a day for the first 3 days, then increase to one pill
twice a day, morning and evening.
-After another 4 days, stop smoking and continue on the pills twice a day.
-After about two months on the pills, gradually stop.
Pts who have trouble sleeping should avoid etoh and caffeine how many hours prior to bedtime?
4-6 hours
What is advanced sleep phase syndrome?
When older adults becomes drowsy at 6-7, maintain an 8 hour sleep, but then wake at 3-4 am
How long should naps be to minimize sleep disturbances?
30-45 minutes
How many hours prior to sleep should you not exercise?
less than 2 hours
Who is the most likely to succeed at suicide?
White, older male
What is the most common means of suicide in the elderly?
Drug overdose
True or false; poverty in itself is a risk factor for suicide
False–not in itself
What are the components of SIGECAPS? How many must one have to be diagnosed? How long?
Sleep Interest Guilt Energy Concentration Appetite Psychomotor Suicidal thoughts
need 5 for 2 weeks
Bereavement changes to depression if it lasts how long?
More than 2 months
A tool used to assess whether a patient is seriously contemplating suicide is the SAD PERSONS scale. What are the components?
Sex (male) Age (less than 19 or over 45) Dx of depression Previous attempts Etoh or substance abuse Rational thinking impairs Social support lacking Organized plan No sig other Sickness
For the SADPERSONS scale, what scores indicated outpt vs inpt treatment
A score of 4 to 6 suggests outpatient treatment is an appropriate clinical action
A score of 7 to 10 suggests hospitalization is warranted
Who should be screened for depression according to the USPSTF?
ALl adults
What are the three lab tests that should be considered to look for organic causes of depression?
CMP
TSH
CBC
What is sleep restriction therapy?
The patient is told to reduce his or her sleep/in-bed time to the average number of hours the patient has actually been able to sleep over the last 2 weeks (as opposed to the number of hours spent in bed [awake plus asleep]). As sleep efficiency increases, time allowed in bed is increased gradually by 15- to 20 minute increments approximately once every 5 days
What is sleep compression therapy?
The patient is counseled to decrease the amount of time spent in bed gradually to match total sleep time rather than making an immediate substantial change.
What is the MOA and use of doxepin?
TCA
What is the MOA and use of phenelzine?
MAOI
True or false: children with pulmonary TB uncommonly present with fever, chills, weight loss etc
True
What is the most common radiographic abnormality for children with pulmonary TB?
Hilar LAD
True or false: in children with pulmonary TB, Infection of the upper lobes of the lung is most commonly seen.
False
Cough from GERD is classically worse at what time of day?
NIght
By what age do the ethmoid and maxillary sinuses develop in children? Frontal?
The ethmoid and maxillary sinuses are clinically significant at birth and reach adult size by 12 and 18 years, respectively.
The frontal sinuses become clinically significant at 6-8 years of life and reach adult size by 18 years.
What are the three criteria used to diagnose bacterial sinusitis?
- Persistence of bilateral nasal discharge of any quality or daytime cough, or both, lasting for more than 10 days without significant improvement (unilateral symptoms suggest a nasal foreign body), OR
- Worsening after initial improvement (“double-sickening”) OR
- High fever and purulent nasal discharge for more than 3 days.
What is the normal inspiratory:expiratory ratio?
1:2 or 1:3
What are the two phases of an asthma attack?
- Bronchial provocation with an allergen causes mast cells and eosinophils to release mediators
- 203 hours later, PMNs, eosinophils, and lymphocytes infiltrate the epithelium, resulting inf destruction, fibrotic remodeling, and hyperplasia
What is cough variant asthma?
Asthma that only has cough as a symptom–no wheezing, SOB, etc
How often should children with new onset asthma be seen in clinic?
- Every 2-6 weeks until their asthma is stabilized, and then
- In 1- to 6-month intervals, depending on level of control and underlying severity.
What are the 6 P’s of compartment syndrome?
P ain
P allor
P ulselessness
P aresthesia (A skin sensation, such as burning, prickling, itching, or tingling.)
P erishing cold (The inability to regulate one’s body temperature.)
P aralysis
What are grades I-III ankle sprains?
I = small tear or just stretching II = incomplete tear and moderate functional impairment III = Complete tear and loss of integrity of ligament
What are the three ligaments on the lateral aspect of the ankle, from anterior to posterior?
ATFL
Calcaneofibular
PTFL
What does the anterior drawer test of the ankle assess?
Integrity of the ATFL
What does the inversion stress test of the ankle assess?
Integrity of the calcaneofibular ligament
What is the crossed leg test that is used in ankle sprains? What does it assess?
Have pt cross bad leg over the good one. Pain with this may indicate a high ankle sprain
What are the ottawa foot rules?
There is pain in the midfoot region AND one of the following: (a) bony tenderness at either
the navicular bone or base of the 5th metatarsal OR (b) inability to bear weight four steps
immediately after the injury and in the emergency department.
What are the ottawa ankle rules?
There is pain in the malleolar zone AND either bony tenderness along the distal 6 cm of the
posterior edge of either malleolus OR inability to bear weight 4 steps both immediately after
the injury and in the emergency department.
What is the treatment for an ankle sprain?
RICE for 72 hours, couple with stretches
How do you elicit lid lag in a pt suspected of having hyperthyroidism?
Ask the patient to follow your finger with their eyes then move your finger slowly from their upper to lower
field of vision. In lid lag, the upper eyelid lags behind the upper edge of the iris as the eye moves
downward. B
What are the antibodies that are elevated in Hashimoto’s thyroiditis?
Anti-TPO
What is the classic, severe side effects of methimazole?
Agranulocytosis
How long does pharmacotherapy take to reduce excess thyroid hormone?
Several months
How often should pts with hypothyroidism on levothyroxine be seen in clinic?
1-2 times yearly
A typical starting dose of thyroxine in primary hypothyroidism (such as that which occurs
following radioactive iodine treatment) is how many mcg/kg?
1.5 mcg/kg
When should DM screening be started in pts without obvious risk factors? How often should tests be repeated if normal?
45 years
q3 years
If a pts BP is over what number should DM screening be done?
135/80
What are cotton wool spots?
Areas of previous hemorrhages in the retina
What is the optimal range for fasting BG levels and 2 hours postprandial for DM pts?
80-120 fasting
Less than 180 - 2hrs postprandial
What are the components of the LEARN model of understanding pts illnesses?
Listen Explain Acknowledge Recommend Negotiate
What should be tested in a DM foot exam?
monofilament PLUS any one of the following:
- vibration using 128-Hz tuning fork
- pinprick sensation
- ankle reflexes (Achilles necessary, but patellar not needed)
What vitamin deficiency has been seen with metformin use?
B12
What is the recommended anti-HTN meds that are more efficacious in the african american population?
Thiazides and CCBs
How often should lipid measurements be obtained for pts on statins?
yearly
What age range for pts with DM should statins be started?
40-75
the ACC/AHA recommends all patients > 21 years old (with or without diabetes) who have an LDL-c greater than what number should be started on statin therapy
190
True or false: all pts with DM, regardless if there is evidence of CVD, should be started on ASA
false
Daily ASA should be started in DM pts if their 10 year risk factor is greater than what percent? What age range?
10%
50-59 years. Beyond that, individual assessment for it.
What is the current A1c goal?
7% or less
Pneumococcal 23-valent polysaccharide (Pneumovax) should be provided to all patients with diabetes over (__) years of age. A one-time revaccination is recommended for patients over (__) years of age if the vaccine was first received greater than (__) years ago
Pneumococcal 23-valent polysaccharide (Pneumovax) should be provided to all patients with diabetes over 2 years of age. A one-time revaccination is recommended for patients over 64 years of age if the vaccine was first received greater than five years ago
Why is it important for DM pts to see their dentist regularly?
Increased glucose in saliva increase bacterial load in the mouth
Type 1 diabetes patients should have their first annual eye exam how many years after diagnosis? Type 2 diabetes patients should have their first dilated exam when?
Type 1 diabetes patients should have their first annual eye exam 5 years after diagnosis. However, type 2 diabetes patients should have their first dilated exam when diagnosed
