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FM Family Med > LearnFM Cards > Flashcards

LearnFM Cards Flashcards

1
Q

How should the patient be set up and supported for an accurate office BP measurement?

A

Back and arm supported
Bladder emptied
Seated comfortably with legs uncrossed x5min
No talking prior to or during measurement

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2
Q

What features of the BP cuff & setup are important for accurate BP measurement?

A

3cm above elbow crease on a bare arm
At level of right atrium
Width of bladder should be 40% of arm circumference
Length of bladder should be 80% of arm circumference

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3
Q

What should be done before assigning a diagnosis of white coat hypertension?

A

24h ambulatory BP readings

Even if pt has record of several at-home readings WNL

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4
Q

What is the cutoff for a Dx of hypertension on home BP monitoring?

A

≥ 135/85 awake average
≥ 120/75 asleep average
≥ 130/80 overall average over 24h

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5
Q

What Ix should be routine on an initial diagnosis of essential hypertension?

A 
Na, K
Cr or eGFR; consider albumin-creatinine ratio
Fasting blood glucose
fasting lipid panel
Urinalysis (blood, protein)
ECG (for LVH)

Other investigations are guided by clinical concern of end-organ damage, or 2y causes of HTN

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6
Q

What cormorbidities/conditions should people with HTN be monitored for?

A 
Dyslipidemia
CKD
DM
CAD
Other end-organ damage
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7
Q

What should you suspect in a young patient with new hypertension?

A

Secondary hypertension: work up for potential causes

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8
Q

What is one common cause of secondary hypertension in young, active people?

A

NSAID use (esp after injury)

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9
Q

What is the foundation of HTN management?

A

Lifestyle changes

  • Salt restriction (6g/d)
  • reduce EtOH intake
  • DASH diet
  • BMI/waist circumference reduction
  • Exercise
  • Smoking cessation
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10
Q

What lifestyle modification has the largest impact on blood pressure?

A

BMI/waist circumference: 5-20mmHg per 10kg lost

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11
Q

What history is important for an infant presenting with a fever?

A 
Feeding
Activity & energy at home
Fever, cough, congestion, diarrhea
Sick contacts, recent travel
PMHx till now
Immunizations
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12
Q

What condition must you have a low threshold of suspicion for in infants?

A

Sepsis

Hx of poor feeding, lethargy, low or high temp all prompt immediate full septic workup and treatment in hospital.

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13
Q

What would you do with an infant presenting to your office with Hx of poor feeding, lethargy, low or high temp?

A

Send to ED: these features all prompt immediate full septic workup and treatment in hospital.

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14
Q

Name 3 risk factors for infant sepsis

A

untreated GBS status
maternal fever during delivery
active vaginal lesions during delivery

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15
Q

How do you manage suspected infant sepsis in a rural hospital?

A

Blood culture as you start an IV
Then up to 3 boluses NS (20mL/kg)
Continue APLS as required

Once stabilized: contact pediatric centre for guidance on empiric Abx, then transfer

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16
Q

What do you try if an infant seems well on exam, is hungry, but has trouble feeding after a few minutes?

A

Nasal suction & then re-feeding

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17
Q

If a child has an erythematous tympanic membrane, no signs of effusion, and symptoms for <48h, how do you treat?

A

Supportive care

Followup in 2d if still symptomatic

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18
Q

How do you manage acute OM + fever in 6-24mo?

A

Treat with empiric Abx, even if symptomatic <2-3d.

Amoxicillin is first line

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19
Q

How do you treat a young child with bronchiolitis?

A

Rx normally not needed

If irritable, elevated RR, signs of decompensation: consider transfer to ED (pediatric)
If you’re in rural ED, O2 + consult peds ED

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20
Q

What is bronchiolitis?

A

viral infection caused by RSV (respiratory syncytial virus)

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21
Q

What is the initial workup for peripheral neuropathy?

A

Diabetic check

B12

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22
Q

When is a cardiac workup indicated for dizziness?

A

Cardiac features, like arrythmias or chest pain

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23
Q

What is the classic triad of Menière’s disease?

A

episodic vertigo, aural fullness and hearing loss

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24
Q

What is the workup for Menière’s disease?

A

Ix: audiometry, MRI of the brain + acoustic meatus

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25
Q

In which patients should you do a CV risk assessment (eg Framingham)?

A

Assess every 5y for women >50 and men >40

Sooner if any risk factors appear

26
Q

When should you initiate screening lipids?

A

All women & men >40 (sooner if risk factors)

27
Q

Who should have VitD supplementation?

A

> 50 years: 400-1000IU daily

<50 years 800-2000IU daily

28
Q

Who should have supplemental calcium?

A

Dietary always preferred to calcium supplements.

Daily intake should be approx 1200mg from all sources

29
Q

Name 5 things on the DDx for back pain (7 listed)

A 
Mechanical
Muscle strain
Disc herniation
Discitis
Vertebral #
Cancer
Arthritis
30
Q

How do vertebral fractures present?

A

moderate to severe pain reproducible on exam

Usually with obvious trauma, though pt with osteoporosis or malignancies may not have trauma Hx

31
Q

What are the basic Hx and exam features of ankylosing spondylitis?

A

20-30 year old age group
Subacute/chronic back stiffness
most pronounced in the morning.

Exam: Lumbar flexion and lateral flexion are reduced.

32
Q

What history raises suspicion for discitis?

A

new onset back pain
fever
Hx of IV drug use, spine surgery, or recent infection

33
Q

What history raises suspicion for neoplasm?

A

Progressive back pain over 6w with unexplained weight loss

34
Q

What is classic ACS chest pain?

A

classic L, crushing, radiation to L arm
Exacerbated by exertion, some SoBoE
ø cough or fever or tenderness on palpation

35
Q

How is costochondritis diagnosed?

A

Dx of exclusion: w/u for ACS first

Pain is reproducible on palpation, and not worse with exertion

36
Q

If a pt presented with pleuritic chest pain, tachypnea and tachycardia, what would you suspect?

A

PE

37
Q

What drugs should be re-evaluated in an elderly pt with recent falls?

A

Benzodiazepines

Alpha 1 blockers (may cause hypotension)

38
Q

What two common medications can worsen CKD when combined?

A

Ibuprofen

ACEi

39
Q

Name 6 contraindications to combined hormonal contraception (11 listed)

A

< 6 weeks postpartum if breastfeeding
smoker over the age of 35 (≥ 15 cigarettes per day)
hypertension (systolic ≥ 160mm Hg or diastolic ≥ 100mm Hg)
current or past history of VTE
ischemic heart disease, history of cerebrovascular accident, cardiovascular disease
migraine with focal neurological symptoms
breast cancer
uncontrolled diabetes or liver disease

40
Q

What kind of contraception can breastfeeding women have?

A

Progestin only (not combined)

41
Q

Which methods of contraception are/can be combined hormonal?

A

cOCP
Transdermal patch
Ring

42
Q

What are potential etiologies of worsening menorrhagia?

A

thyroid issues, fibroids, coagulopathies, polyps or endometrial hyperplasia/cancer

43
Q

What should a patient do if they miss a pill (of cOCP)?

A

Take the pill as soon as possible along with backup contraception, then resume regular method

44
Q

What forms of emergency contraceptive are available in Canada? How long are they effective?

A
  • copper IUD (effective up to 7 days after intercourse)
  • high dose combined oral contraceptive (Yuzpe method)
  • progestin only emergency contraceptive (ie Plan B)

The hormonal methods are most effective the first 72 hours but can be used up to 5 days. The earlier the intervention the more effective.

45
Q

What domains of care should be asked about when discussing goals of care?

A 
resuscitation measures (chest compression, intubation)
life support measures (mechanical ventilation)
life sustaining measures (Abx, transfer to ICU)
46
Q

True or false: once you’ve had a goals of care conversation, you don’t need to have it again.

A

False: Remember goals of care can shift, and convo can be had more than once

47
Q

When should the first postnatal visit take place?

A

1w

48
Q

How much of their birth weight is a baby expect to lose in the first week? By when should they regain it? What other features should you assess?

A

Up to 10%
By 7-10d [other source said 2w]

If they appear well, feed well, and have appropriate stool pattern and urine output

49
Q

What is the simple formula for estimating a due date?

A

Naegele’s rule: add 7d and subtract 3mo

E.g. LMP Feb 7 → Nov 15

50
Q

What recommendations should be given in preconception counselling?

A
  • optimize meds (remove teratogens)
  • Folic acid 0.4-5mg
  • avoid alcohol
  • weight optimization / healthy habits
51
Q

When is gestational diabetes screening done? What screening should be done before conception?

A

GDM screening is at 24-26w

No screening for DM is needed prior to pregnancy

52
Q

What is gold standard for Dx of COPD?

A

Spirometry: FEV1/FVC <0.7

53
Q

What is the only intervention that is shown to slow the rate of lung function and decline in COPD?

A

Smoking cessation

54
Q

What vaccines are routinely recommended in people with COPD?

A

Influenza and pneumonia

COPD confers increased risk of complications from influenza and pneumonia

55
Q

What are the most common causes of chronic cough?

A 
ACEi use
asthma
environmental triggers
gastroesophageal/laryngeal reflux disease
upper airway cough syndrome
56
Q

What is a common mimic of depression, that can be managed by family doctors? Name one clinical feature that can help distinguish it from depression

A

Hypothyroid

Cold intolerance

57
Q

What therapy may be effective for patients who present with seasonal (winter) depressive features?

A

Light therapy

first line, over pharmacotherapy

58
Q

Who should be screened for diabetes, and how often?

A

all adults >40 using either a fasting plasma glucose or an A1C every 3 years

If elevated risk, screen more frequently (every 6-12mo)

Reassess risk annually (eg CANRISK calculator)

59
Q

When should an adult be immediately tested for diabetes?

A

If they develop symptoms/clinical suspicion (fatigue, polyuria, blurry vision, etc)

60
Q

What are the risk factors for sleep apnea?

A 
STOP-BANG:
Snoring
Tired
Observed apnea
Pressure (HTN)
BMI
Age > 50
Neck size
Gender: male
61
Q

What is the initial workup for suspected CHF?

A

ECG
Echo
CXR

62
Q

In a patient with fatigue, weight loss, a cough, and diminished breath sounds, what would your initial workup be?

A

Cancer suspected: broad but targeted investigations

CBC: underlying Sx of malignancy
Creatinine: kidney dysfunction
CXR: evidence of adenopathy

FM Family Med (1 decks)

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