FM Cases Flashcards
1
Q
What is the single risk factor that is responsible for the most death?
A
Smoking
2
Q
What are grades 1-5 of the diabetic foot ulcer grading system?
A
- Grade 1: Diabetic ulcer (superficial)
- Grade 2: Ulcer extension (involving ligament, tendon, joint capsule or fascia)
- Grade 3: Deep ulcer with abscess or osteomyelitis
- Grade 4: Gangrene forefoot (partial)
- Grade 5: Extensive gangrene of foot
3
Q
What criteria must be met to treat a pt with a DVT as an outpatient? (3)
A
- Hemodynamically stable
- Good kidney function
- Low risk for bleeding
4
Q
True or false: rivaroxaban alone is sufficient to treat a pt with a DVT
A
True
5
Q
What are the five major advantages of LMWH over unfractionated heparin?
A
- Longer half life
- No monitoring needed
- Lower risk of HITT
- Fixed dosing
- May be used in outpatient setting
6
Q
How long are pts with an unprovoked or provoked DVT anticoagulated for after resolution?
A
3 months unless 2/2 CA. Then no set stopping date
7
Q
True or false: it is appropriate to screen all pts with a h/o DVT for a thrombophilia
A
False–not all, but those with obvious risk factors, or unprovoked
8
Q
What is the half-life or warfarin?
A
40 hours
9
Q
How long does dabigatran need to overlap with LMWH?
A
5 days
10
Q
How can anemia lead to palpitations?
A
Loss of blood = tachycardia
11
Q
True or false: menopause can cause palpitations
A
True
12
Q
A systolic murmur at the left sternal border that increases with Valsalva maneuver would suggests what?
A
HOCM
13
Q
True or false: pulsating chest pain is more concerning for ACS
A
False–less concerning
14
Q
When does age become a risk factor for heart disease?
A
Over 55 for women and over 45 for men
15
Q
Does ASA decrease the risk of ischemic stroke
A
No
16
Q
True or false: ASA decreases the risk of MI in men
A
True
17
Q
Difficulty with heel walk is associated with (___) disc herniation
A
Difficulty with heel walk is associated with L5 disc herniation
18
Q
Difficulty with toe walk is associated with (___) disc herniation
A
Difficulty with toe walk is associated with S1 disc herniation
19
Q
What etiology of LBP classically improves with squatting?
A
spinal stenosis
20
Q
LBP that worsens with flexion is suspicious for what etiology?
A
Herniation
OA
Muscle spasm
21
Q
LBP that worsens with extension is suspicious for what etiology?
A
DJD
Spinal stenosis
22
Q
What indicates a positive SLR?
A
The test is positive if pain radiates down the posterior/lateral thigh past the knee. This radiation indicates stretching of the nerve roots (specifically S1 or L5) over a herniated disc.
23
Q
At what degree of leg movement during the SLR is indicative of malingering?
A
- True pain will most likely occur between 40 and 70 degrees.
- Pain earlier than 30 degrees is suggestive of malingering.
24
Q
What does the crossed SLR do?
A
If disc is herniated, will compress on the nerve roots of the contralateral side. Very specific test, but not sensitive.
25
What are the s/sx of a disc herniation, besides back pain?
Pain worse with sitting
Pain worse with coughing/sneezing
Drop foot
26
What is the usual prognosis for disc herniation?
Self limited most of the time--resolves in two weeks
27
True or false: leg numbness with LBP is a red flag symptom
False--can be seen with simple disc herniations
28
What are the indications for obtaining an x-ray for LBP in a pt, besides obvious trauma?
Strenuous lifting in patient with osteoporosis
Prolonged steroid use
Osteoporosis
Age <20 and >70
History of cancer
Fever/chills/weight loss
Pain worse when supine or severe at night
29
What is the timeframe for which LBP merits an MRI?
More than six weeks of conservative care
30
What is the recurrence rate of LBP?
35-75%
31
Patients older than what age take longer to recover from episodes of LBP?
45
32
What is the usual presentation of chondromalacia patellae?
Anterior knee pain worsens with sitting for long periods
33
What is the first choice medicine for the treatment of OA?
Acetominophen
34
HOw often and how frequently can steroid injections be given for OA?
No more than once per month, and no more than three per year
35
What is the relative sensitivity and specificity of tinel's and phalen's maneuver for carpal tunnel?
Somewhat useful with lower sensitivities and higher specificities
36
What is the first line treatment for carpal tunnel?
Nightly wrist splint
37
What is the most common side effect of opioids?
Constipation
38
Which opioids have a higher risk of tolerance: short or long acting
Short
39
What is a major issue with using carbamazepine for neuropathic pain?
p450 inducer
40
When does colorectal screening stop?
age 75
41
When does breast CA screening stop?
age 75
42
When does cervical CA screening stop?
age 65 if they have had normal paps up until this point
43
When is the pneumovax indicated?
Age 65 or those with DM or COPD
44
When is the 13 valent pneumo vaccine indicated?
one year after pneumo 23
45
When is the varicella vaccine indicated?
If over 60 years
46
What is the major side effect of tramadol?
Seizures
47
What is the normal synovial fluid color?
Straw colored
48
Which comes first in the case of a suspected septic arthritis: PCR or culture?
PCR
49
True or false: warfarin is a contraindication to NSAID use for OA
True--have anticoagulant effects
50
What are the classic CXR features of silicosis?
Calcifications of the hilar lymph nodes
51
What is POEMS syndrome?
```
Polyneuropathy
Organomegaly
Endocrinopathy
Monoclonal protein
Skin changes
```
52
What are the s/sx of POEMS syndrome, besides the POEMS symptoms?
Sclerotic bone lesions
Anemia
hyperuricemia
53
What is the diagnostic test for POEMS syndrome? What does this show?
Urine and serum electrophoresis
| Shows a monoclonal M spike
54
Is the rash in pityriasis rosea pruritic?
Yes
55
What is the prognosis for pityriasis rosea?
Self limiting within a few months
56
What are the two major sulfonylureas?
Glipizide
| Glyburide
57
What are the electroscopic findings of carcinoid tumors?
Dense core granules
58
Pleural plaques on CXR = ?
Asbestosis
59
What are the auscultatory findings of asbestosis?
Fine end inspiratory crackles
60
How can NSAIDs worsen dilated cardiomyopathy?
increase afterload and affect cardiac output by inhibiting prostaglandin synthesis (eliminated their effects on vasodilation) and by counteracting the benefits of ACEIs
61
What is the pathophysiology of the restrictive lung disease caused by coal pneumoconiosis?
Macrophages eat up the coal, and fibrosis in response
62
What are the cardiac manifestations of silicosis?
cor pulmonale
| RVH
63
What are the components of the HEEADSSS mnemonic for preparticipation exams in adolescents?
```
Home
Education / Employment
Eating
Activities
Drugs
Sexuality
Suicide / Depression
Safety / Violence
```
64
Who should be screened for chlamydia? (2)
Women over 25 years who are at high risk, and all sexually active women under 25.
NOT:
- prego
- men
- low risk women
65
What supplement should all sexually active women take in case of pregnancy?
Folic acid
66
What environmental situations should prego pts avoid?
Hot tubs or hot areas
67
What is the caffeine intake recommendation for pregos?
No more than two cups / day
68
What is chadwick's sign?
Bluish/purple hue to the vagina with pregnancy
69
What is Goodell's sign?
Softening of the cervix with prego
70
What is Hegar's sign?
Softening of the uterus
71
When are fetal heart tones first heard?
10-12 weeks
72
What are fetal movement first felt?
18-20 weeks
73
What is a common cause of bleeding early in pregnancy?
When trophoblasts attaches to the uterine wall ("implantation bleed")
74
Up to how many weeks is an abortion legal?
22 weeks
75
How accurate is the estimated gestational age based on the LMP?
Usually actual age is two weeks less than EGA
76
What is Naegele's rule for determining the due date of a prego?
LMP, Add 1 year
Subtract three months
add 1 week
(or, more concisely, add 9 months and a week from LMP)
77
When is rhogam indicated in vaginal bleeding episodes?
Always, regardless of gestational age
78
What percent of prego women experience vaginal bleeding in their first trimester? What are the chances of miscarriage?
1/4 experience bleeding
| 25-50% chance of miscarriage
79
What is a cervical ectropion? What is its significance?
When the central part of the cervix appears red from the mucous-producing endocervical epithelium protruding through the cervical os, onto the face of the cervix. It has no clinical significance and is common in women who are taking oral contraceptive pills.
80
What is the role of progesterone in a threatened miscarriage?
If the result is >25, it is highly associated with a sustainable intrauterine pregnancy. If the result is <5, it is highly associated with an evolving miscarriage or ectopic pregnancy. Levels between 5 and 25 have minimal diagnostic value in distinguishing intrauterine from ectopic pregnancy
81
What is the normal progress of bHCG in pregnancy?
Doubles every 48 hours in the first 6-7 weeks.
82
What hCG level indicates that a fetus will be detectable by a transvaginal US? Transabdominal?
```
Transvaginal = 1500-1800
Transabdominal = over 5000
```
83
What happens to beta-hCG levels in an ectopic pregnancy?
Rise slower than usual
84
What is the measure that is used to determine EGA by US in the first trimester?
Crown-rump length
85
What are the four measures that are used to determine EGA by US in the second trimester?
1. biparietal diameter
2. head circumference
3. abdominal circumference
4. femur length
86
When is US gestational age preferred over LMP dating?
If the EGA & EDD from the ultrasound measurements are within one week of the EGA / EDD estimated from the LNMP, today's gestational age and the due date (EGA & EDD) should not change to reflect the ultrasound calculations, as in this case.
If, however, the ultrasound measurements suggest an EGA & EDD that is greater than seven days from the EGA & EDD calculated from the LNMP (or, in some cases, if the LNMP is historically inaccurate), then the estimated gestational age today, as well as the estimated due date, should be changed to reflect the ultrasound measurements and estimates.
87
What happens to dating a pregnancy as it progresses? Why?
Less and less accurate
This is because of the response of the fetus to internal and external insults. During the 1st and 2nd trimester, many problems that develop result in pregnancy loss and/or teratogenensis. However, during the third trimester, many of fetal and maternal challenges manifest themselves in fetal growth.
88
What is the definition of threatened abortion?
Bleeding before 20 weeks gestation
89
What is an inevitable abortion?
dilated cervical os
90
What is an incomplete abortion?
some but not all of the intrauterine contents have been expelled
91
What is a missed abortion?
fetal demise without cervical dilitation and/or uterine activity (often found incidentally on ultrasound without a presentation of bleeding).
92
What is a septic abortion?
with intrauterine infection (abdominal tenderness and fever usually present).
93
What is a complete abortion?
The products of conception have been completely expelled from the uterus.
94
What is the medical therapy for an inevitable abortion?
Vaginal administration of 800 mcg of misoprostol (Cytotec), possibly repeated on day three. Success with this method is generally around 95%, and the time to completion is generally 3-4 days (but may take up to 2 weeks), as opposed to 2-6 weeks with expectant management.
95
True or false: most women who have a miscarriage will not have another
True, but biggest risk factor for miscarriages is h/o them
96
True or false: physical and emotional stress can cause miscarriages
false
97
What is the amount of folate that a women with DM or epilepsy should take prior to getting pregnant? What about a woman with a h/o delivering a baby with a NTD?
1 mg for the diabetic
4 mg for the NTD history
400-800 mcg for all others
98
True or false: a PE can cause wheezing
True
99
True or false: pneumonia can cause wheezing
False
100
True or false: OSA can cause wheezing
False
101
True or false: CHF can cause wheezing
True
102
True or false: epiglottitis can cause wheezing
False
103
True or false: upper airway cough syndrome (post nasal drip) can cause wheezing
True
104
True or false: persistent bronchitis can cause wheezing
True
105
How long can acute sinusitis last for, prior to becoming chronic?
12 weeks
106
True or false: clear drainage is associated with acute sinusitis
False
107
What are the four criteria to diagnose chronic sinusitis? How many are needed to dx?
Two of the following:
- nasal obstruction or congestion
- mucopurulent drainage (anterior, posterior or both)
- facial pain, pressure or fullness
- decreased sense of smell
108
What conditions classically worsen sinusitis? (4)
Obesity
OSA
Depression
GERD
109
What is the indication for a methacholine challenge?
Normal PFTs, but continued s/sx
110
What are the mainstays of treatment for sinusitis? (2)
Oral antihistamines
| Inhaled nasal corticosteroids
111
What are the diagnostic criteria for asthma?
FEV1 increased by at least 12% after bronchodilator therapy
112
What is the diagnostic test for eosinophilic bronchitis?
Eosinophils in the sputum
113
What are the symptoms, FEV1, and medications for mild, intermittent asthma?
Up to 2 days/week
Up to 2 nights /month
Over 80% FEV1
PRN albuterol
114
What are the symptoms, FEV1, and medications for mild, persistent asthma?
More than 2 times/week or 2 nights / month but less than once a day
FEV1 over 80%
Daily low dose corticosteroids
PRN albuterol
115
What are the symptoms, FEV1, and medications for moderate, persistent asthma?
Daily s/sx
More than 1 night a week
FEV1 60-80%
Corticosteroids, long acting b2 agonist, and PRN inhaler
116
What are the symptoms, FEV1, and medications for severe, persistent asthma?
Continual, frequent symptoms
FEV1 less than 60%
High dose steroids + long acting beta agonist
PRN albuterol
117
What is the most effective treatment for allergic rhinitis?
Nasal corticosteroids
118
Is asthma an indication for the pneumonia vaccine?
Yes, but only the 23 variant
119
Who should get the pneumovax-13?
Elderly, young, or those with COPD/DM
120
What is an indication of a severe asthma attack in terms of peak flows?
Less than 50% of peak flow--80% is good control
121
What are the number of symptoms that qualify for mild, moderate, and severe alcohol use disorder?
Mild: Two to three symptoms.
Moderate: Four to five symptoms.
Severe: Six or more symptoms.
122
What is the definition of heavy drinking?
Consuming five or more alcoholic drinks on a single occasion, five or more days in a 30-day period.
123
What hCG concentrations are home pregnancy tests positive? Serum hCG?
```
Home = 25 mlU/mL
Serum = 5
```
124
When can the gestational sac be visualized with a transvaginal US?
4-5 weeks
125
When should the first transvaginal US be performed?
ASAP, but not later than 20 weeks
126
Most clinicians will use dates determined by ultrasound for any discrepancy in what three situations?
more than one week between the ultrasound and another method in the first trimester
more than two weeks in the second trimester
more than three weeks third trimester
127
True or false: in the third trimester, fundal height measurements have the same accuracy as US
True
128
Is intimate partner violence more or less common in pregnancy?
More
129
What is the test for Hep B in pregnancy?
Surface antigen--core etc will be done if this is positive
130
How often should a UA be obtained in pregnancy?
At every prenatal visit
131
When should a pap smear be obtained in pregnant women?
12-16 weeks gestation
132
When should a hep C test be performed in pregnancy?
Only if high risk for
133
When should varicella testing be performed in pregnancy?
Women should be asked about a history of chicken pox; women with no history can have serologic testing for varicella zoster IgG. Non-immune women should be offered preconception or postpartum varicella vaccination. Varicella vaccination is contraindicated in pregnancy.
134
When should herpes testing be performed in pregnancy?
All pts should be asked and counseled
Women with a history of recurrent HSV should be counseled about the use of antiviral medicine (such as acyclovir) to reduce risk of cesarean delivery due to active lesions at the time of delivery (the presence of active lesions during labor is a contraindication for vaginal delivery).
135
When should screening for BV be done in pregnancy?
Not recommended unless symptomatic
136
When should toxoplasmosis screening be performed in pregnant women
Not recommended
137
When should CMV screening be performed in pregnant women
Not recommended
138
When should parvovirus screening be performed in pregnant women
Not recommended
139
How often should pregnant women be seen for prenatal visits?
every 4 weeks until 28 weeks gestation.
Then, q2 weeks from 28-36 weeks
Finally, weekly 36 weeks on
140
When does the neural tube close?
4 weeks
141
When does the heart begin to beat in pregnancy?
8 weeks
142
When do the heart, spine, arms, legs, and other organs begin to take shape in pregnancy?
1-12 weeks
143
True or false: prolonged standing is good for pregnant women
false--linked to complications
144
What is the recommendation for exercise in pregnant women?
30 minutes on most days of the week
145
What are the risks of hot tubs and sauna use in pregnancy?
NTDs
| miscarriages
146
What is the recommendation regarding fish eating in pregnancy?
Don't eat--Hg
147
What is recommendation for the use of aspartame in pregnancy?
Fine in moderate amounts if mom does not have PKU
148
What is the recommendation regarding saccharin use in pregnancy?
Do not use.
149
For expecting mothers whose BMI is between 18.5-25, what is the expected amount of weight gain?
25-35 lbs
150
For expecting mothers whose BMI is between 25-30, what is the expected amount of weight gain?
15-25 lbs
151
For expecting mothers whose BMI is 30 and above, what is the expected amount of weight gain?
10-20 pounds
152
When does the fundal height correspond to the weeks gestation?
20 weeks +
153
When does the fundus become palpable in prego?
10 weeks ish
154
When does serum screening for chromosomal abnormalities begin?
15-21 weeks
155
When is Rhogam given to pregnant women?
At 28 week and 72 hours prior to delivery
156
IS the flu vaccine recommended for pregnant women?
Yes, but only the injection
157
What are the components of the triple screen?
AFP
hCG
Unconjugated estriol
158
What are the components of the quad screen?
AFP
hCG
Unconjugated estriol
dimeric inhibin A
159
What is the screen for NTDs, and when is it performed?
10-14 weeks
| Nuchal translucency + biomaker
160
When is chorionic villus sampling performed in pregnancy?
First trimester
161
When is amniocentesis performed in pregnancy?
second trimester
162
Routine US screening for fetal anomalies is recommended starting when?
18-20 weeks
163
What are the dietary measurements for n/v in early pregnancy?
- frequent, small meals
- Solid foods should be bland
- Salty food in morning, sour/tart liquids better than water
164
When does the n/v in pregnancy usually occur?
4-20th week
165
When can sex be determined by US for fetuses?
18 ish weeks
166
What is the sensitivity of a quad screen for fetal anomalies?
80%
167
What is the sensitivity of the triple screen?
70%
168
What is the rate of spontaneous abortion 2/2 amniocentesis?
1/300 - 1/500
169
What is the prognosis for placental previa early on in the pregnancy (21 weeks or under)?
Spontaneously resolve
170
What are the risk factors for placenta previa? (5)
- have had a prior pregnancy
- are older (>35)
- smoke
- have had twins or a higher multiple pregnancy
- have had previous uterine surgery, including prior cesarean section
171
True or false: partial or marginal placenta previas are less likely to resolve on their own compared to complete placenta previas
False--more likely to resolve
172
What is the management for placenta previa after found with US?
- US surveillance, and monitoring for bleeding
| - If not resolved by delivery time, then c-section
173
What are the components of anticipatory guidance at 23 weeks? (3)
Breastfeeding talk
Car seats
Contraception s/p delivery
174
When should screening for gestational DM be performed?
24-28 weeks
175
What is the definition of chronic HTN in pregnancy defined as?
Blood pressure elevation first detected before the 20th week of pregnancy that persists beyond 12 weeks postpartum.
176
What is the definition of gestational HTN in pregnancy defined as?
The presence of persistent systolic blood pressure of ≥140 mmHg and/or a diastolic blood pressure of ≥90 mmHg, without proteinuria, in a previously normotensive pregnant woman at or after 20 weeks of gestation.
177
What is the definition of preeclampsia defined as?
The presence of persistent systolic blood pressure of ≥ 140 mmHg and/or a diastolic blood pressure of ≥ 90 mmHg, with proteinuria of 0.3 grams or greater in a 24-hour urine specimen.
178
What are the risk factors for eclampsia?
White, nulliparous women from lower socioeconomic backgrounds are at higher risk, and the incidence appears to be higher in younger (teenage and low twenties) and older (> 35 years) women.
179
What is the risk of developing eclampsia in women with mild and severe preeclampsia respectively?
Eclampsia occurs in about 0.5% of women with mild preeclampsia and in about 2-3% of women with severe preeclampsia.
180
What are the s/sx of severe preeclampsia?
- Visual disturbances
- HAs
- N/v
- RUQ pain
- Decreased urine output
181
When does the fetus begin to breathe and open eyes?
27-ish weeks
182
What are the criteria for the fasting glucose tolerance test in pregnancy?
Need two or more of the following:
- Fasting serum glucose concentration ≥ 95 mg/dL
- One-hour serum glucose concentration ≥ 180 mg/dL
- Two-hour serum glucose concentration ≥ 155 mg/dL
- Three-hour serum glucose concentration ≥140 mg/dL
183
When is screening for gestational DM done?
27 weeks
184
When does GBS screening start?
35-37 weeks
185
True or false: it is standard practice to perform urine screening for GBS
False
186
What are the first and second line choices for GBS in pregnancy?
PCN
| Ampicillin
187
What is PUPPP? What are the s/sx? When does it occur? treatment?
-pruritic urticarial papules and plaques of pregnancy
-Trunk and extremity lesions that are treated with low dose steroid and topical lotions
-
188
What are the components of the birth plan for pregnant women?
- who will be present
- strategies for pain management
- Comfort measures
189
What is the usual presentation of placenta previa?
Bright red, painless vaginal bleeding after 20 weeks w/o contractions (usually)
190
What is the management for placenta previa?
Stop sexy time
191
What is the presentation of placental abruption?
Vaginal bleeding with associated abdominal pain, contractions, and non-reassuring FHTs
192
What is the treatment for placental abruption?
some are self limited if small, but sometimes c-section if fetus oxygen/nutrient supply significantly disrupted
193
What is the definition of preterm labor?
Labor beginning before 37 weeks
194
What is the usual presentation of uterine rupture?
Bleeding
Fetal distress
expulsion of the uterine wall and overlying serosa
195
What is the treatment for uterine rupture?
C-section with uterine repair or hysterectomy
196
What is the treatment for BV in pregnancy?
Metronidazole 500 mg BID x 7 days
197
What is the treatment for a UTI?
Cipro 500 mg BID x 7 days
198
What is the treatment for vaginal candidiasis?
Clotrimazole cream, 1 vaginal applicator full per vagina BID x 7 days
199
What is the Moro reflex? What happens to this reflex with Down syndrome?
Air grabbing reflex when head is let down suddenly
Decreased reflex with downs
200
What type of contraception is contraindicated in the recent postpartum woman?
Estrogen containing since it interferes with breast milk
201
How long do postpartum blues typically last?
2 weeks
202
What is the post natl depression scale used to screen for postpartum depression?
Edinburgh
