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Family Med > Med-U cases > Flashcards

Med-U cases Flashcards

1
Q

Increased risk of breast cancer

A

A patient has an increased risk of breast cancer if a first-degree relative has had breast cancer (parent or sibling)

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2
Q

Self-Breast examination

A

Breast self-examination actually increases the number of biopsies performed.
Patients who choose to perform self-examination should be trained in appropriate technique and follow-up.
Self breast exam allows motivated women to be in control of this aspect of their health care and allows for patient autonomy and education.

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3
Q

Cervical Cancer Screening Guidelines

A

At 21 years of age - cervical cancer screening should begin
Between the ages of 21-29 years - screening should be performed every three years
Between the ages of 30-65 - screening can be done every three years with cytology alone, or every five years if co-tested for HPV
Risk groups need to have more frequent screening

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4
Q

Risk groups for cervical cancer

A

Women with compromised immunity, HIV positive, history of CIN grade 2,3 or cancer, or have been exposed to DES
Early onset of intercourse, multiple sexual partners, cigarette smoking, immunosuppressed patient.

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5
Q

Characteristics of a Good Screening Test

A

Accuracy (high sensitivity and specificity)
Able to detect disease in an asymptomatic phase
Minimal associated risk
Reasonable cost
Acceptable to patients

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6
Q

Additional Cancer screening with pelvic and breast exams

A

Skin exam for malignant melanoma

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7
Q

Suspicion of malignancy in breast exam

A

Presence of a single, hard, immobile lesion of approximately 2 cm or larger with irregular borders

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8
Q

Risk factors for breast cancer

A

Family history of breast cancer in first degree relative, prolonged exposure to estrogen, genetic factors, obesity, excessive alcohol intake, and age.

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9
Q

Perimenopause

A

The gradual transition to menopause. Ovaries slow down, still possible to get pregnant. Can last from 2-8 years.

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10
Q

Calcium intake for women

A

Premenopausal women need 1000mg of calcium daily while postmenopausal women need 1500 mg of Ca.

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11
Q

Osteoporosis Screening

A

For women >65 years - screening with dual energy x-ray absorptiometry is recommended
For women s fracture assessment tool to risk stratify. Screening is recommended if their risk is as high as that of a 65 year old (9.3 percent over 10 years)

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12
Q

Risk factors for osteoporosis

A

Early menopause, sedentary lifestyle, white race, history of previous fracture, family history of osteo fracture, dementia, and smoking.

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13
Q

RISE mnemonic for preventive visits

A

Risk factors
Immunizations
Screening tests
Education

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14
Q

Most frequent causes of death for a 55 year old man

A

Malignant neoplasm, heart disease, unintentional injury, diabetes, chronic lung disease, chronic liver disease, cirrhosis

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15
Q

Risk factors for CVD and ASCVD

A

Sedentary lifestyle, stress, premature family history, excess alcohol use, current smoking (major risk factor)
Symptoms of CVD - Leg pain with activity, chest pain with activity

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16
Q

Effectiveness of oral medications

A

Somewhat effective (quit rate at 12 mos, 1.5-3 times the placebo quit rate)

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17
Q

Interventions which improve quit rates of smoking

A
  1. Quit rates are highest when patients are engaged in a group setting.
  2. Oral medications are somwhate effective at helping people stop smoking
  3. When combined with medication, a series of one-on-one counseling sessions enhances quit rates
  4. Providing practical problem-solving skills, assistance with social supports, and use of relaction/breathing techniques can increase quit rates
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18
Q

Gathering a Complete Nutrition History

A

24-hour dietary recalls, Food frequency questionnaire, Daily dietary intake records, usual diet history, observed intake, weighed intakes

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19
Q

BMI

A

Underweight - below 18.5
Normal 18.5-24.9
Overweight 25-29.9
Obese 30+

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20
Q

Importance of BMI

A

Risk factor for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease

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21
Q

Changes associated with dyslipidemia

A

Corneal arcus, xanthelasmas, acanthosis nigricans

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22
Q

Changes associated with atherosclerosis

A

Decreased peripheral pulses, carotid bruit

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23
Q

USPSTF Screening Recs for a 55 yo asymptomatic smoker

A

Colorectal cancer, obesity, diabetes mellitus, lipid disorders, tobacco use, lung cancer screening, hypertension, alcohol misuse, hep C, depression

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24
Q

Colon Cancer screening options

A

Screening every 10 years
Annual testing of three stools for blood and a flexible sigmoidoscopy test every 5 years
Double-contrast enemas every five years
CT colography is experimental

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25
Q

ECG changes suggesting coronary artery disease

A

ST segment depression or downsloping ST segment. Convex ST segment elevation. Q waves.

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26
Q

What treatments for primary insomnia are proven in the elderly

A

CBT and Zopidem

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27
Q

Which of the following medical conditions is associated with depression

A

Hypothyroidism, Parkinson’s disease and Dementia.

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28
Q

What factors increase a patient’s risk for completed suicide

A

Male gender, older age, and having a previous suicide attempt

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29
Q

Assessing for Severity of Suicidal Ideation

A 
SAD PERSONS
Sex(male)
Depression (diagnosis of)
Previous attempt(s)
Ethanol or other substance abuse
Rational thinking impaired (psychosis, delusions, hallucinations)
Social supports lacking
Organized plan for suicide
No significant other
Sickness (physical illness)
30
Q

Common side effects of SSRIs and SNRIs

A

Headaches, Insomnia, nausea

31
Q

Fatigue panel

A

CMP, TSH, CBC

32
Q

Depression in Hispanics

A

They are less likely to be diagnosed than non-Hispanic whites
They are more likely to present with somatic complaints

33
Q

Compartment Syndrome

A

Serious life and limb-threatening complication of extremity trauma
Rising pressure in a muscle compartment impairs perfusion to that same compartment
Causes: Fractures, crush injuries, burns, and arterial injuries.
Need high clinical supsicion, as delay in diagnosis or treatment can lead to compromised blood supply, nerve damage, and muscle death.
Treatment: Emergent decompression via fasciotomy
Signs and symptoms (the “6 Ps”): Pain, pallor, pulselessness, paresthesias, poikilothermia, and paralysis.

34
Q

Toxic Diffuse goiter (Graves disease)

A

Causes majority of (60-80) of hyperthyroidism
Autoimmune disease cause by an antibody that acts at the TSH receptor and stimulates the gland to synthesize and secrete excess thyroid hormone
Females 5-10 times more likely to have it than males
Age of peak incidence: 40-60 years
Associated with family history of thyroid disease and other autoimmune diseases
Triggers: Stressful life events, high iodine intake, recent pregnancy
Hypervascularity of the thyroid may result in a bruit or thrill upon auscultation that is not present in other etiologies of hyperthyroidism
Pretibial myxedema

35
Q

Toxic nodular goiter

A

Causes about 5% if cases of hyperthyroidism
Thyroid nodules are common, but most are not symptomatic, and only 4-5% are cancerous
Thyroid nodules are more common in patients over 40. These older patients more often have multinodular disease, whereas solitary nodules are seen more often in younger patiens and can be associated with iodine deficiency

36
Q

Thyroiditis

A

Disease in which thyroid hormone leaks from an inflamed thyroid, typically short-term. May happen after a viral illness or pregnancy

37
Q

Excessive iodine

A

May occur through diet or a medication (amiodarone), which can induce thyroiditis but also has high iodine content

38
Q

Causes of goiter (enlarged thyroid gland)

A

lack of iodine, hashimoto’s disease, graves’ disease, nodules, thyroid cancer, pregnancy, thyroiditis

39
Q

Hypothyroidism

A

weight gain, cold intolerance, pedal edema, heavy periods, fatigue

40
Q

End-Organ Damage Caused by Diabetes

A

Coronary heart disease, Cerebrovascular disease, retinopathy, neuropathy, nephropathy

41
Q

Hyperosmolar hyperglycemic state (HHS)

A

Dehydration, Plasma glucose levels >600 mg/dL, and ketones are absent or mildly elevated

42
Q

LEARN

A

Listen with empathy, Explain your perceptions, Acknowledge, Recommend treatment, Negotiate treatment

43
Q

Diagnostic Criteria for Diabetes Mellitus

A
  1. A random glucose of 200 mg/dL, plus symptoms of hyperglycemia like polyuria or unexplained weight loss or hyperglycemic crisis
  2. A fasting plasma glucose of greater than or equal to 126 mg/dL
  3. A hemoglobin A1C greater than or equal to 6.5%
  4. Oral Glucose Tolerance Test is not recommended
44
Q

Screening for Type 2 Diabetes

A

Physical inactivity, Race/ethnicity, First-degree relative, previously impaired glucose, hypertension, HDL cholesterol, Hx of gestation diabetes, PCOS, Hx of cardiovascular disease, A1C >5.7%, (acanthosis nigricans, severe obesity)
In the absence of the above, screening should begin at 45 years of age
3. If results are normal 3 year intervals

45
Q

Foot exam

A 
Testing for loss of protective sensation
Ankle reflexes
Assessment of pedal pulses
Inspection 
Skin changes such as hair loss and temperature changes
46
Q

Vaccines for patients with diabetes

A

Influenza vaccine, Pneumococcal, hep B

47
Q

Causes of mortality in the U.S.

A
  1. Smoking
  2. Obesity
  3. Diabetes
  4. Hypertension
48
Q

Known health risks of obesity

A

HTN, Dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratry problems, endometrial cancer, breast cancer, colon cancer

49
Q

Cellulitis

A

Acute inflammatory condition of the skin characterized by localized pain, erythema, swelling, and heat. Small breaks of skin are associated with streptococcal infection, whereas staphylococcal cellulitis is commonly associated with larger wounds, ulcers, or abscesses. This is likely an acute, unilateral process.

50
Q

DVT

A

Symptoms include acute swelling, pain, and discoloration in the affected extremity. Physical exam may reveal the palpable cord of a thrombosed vein, unilateral edema, warmth, and superficial venous dilation. Homan’s sign (pain on passive dorsiflexion of the foot), edema, tenderness, and warmth. Smoking and obesity are the most robust risk factors.

51
Q

Well’s criteria for diagnosis of DVT

A

Active cancer (treatment ongoing or within previous six months, or palliative)
Paralysis, paresis, or recent plaster immobilization of the legs
Recently bedridden for more than three days, surgery within past four weeks
Localized tenderness along the distribution of the deep venous system
Entire leg swollen
Calf swelling by more than 3 cm compared with the asymptomatic leg
Pitting edema
Collateral superficial veins
Alternative diagnosis as likely as or more likely than DVT (subtracts 2 points)
3 points = high probability, <0 = low probability

52
Q

Treatment duration with anticoagulation for DVT

A

Isolated calf thrombophlebitis 6-12 weeks
First time event as a result of trauma or surgery >3mos
First episode of idiopathic >6 mos
Recurrent thromboembolic disease or inherited: 12 mos to indefinitely

53
Q

Warfarin titration

A

The half-life of warfarin is approx 40 hours so it takes 5-7 days to reach stable state
Check INR 3 days after warfarin initiation to make sure it is not too high.
If 59, hold warfarin and repeat INR in 24 hours
If x>9, hold warfarin and give an oral dose of vitamin K

54
Q

Classification of HTN

A

Normal 140/90; >60yo >150/90

55
Q

Which elements of an initial focused history are most important to gather in a patient with a possible new diagnosis of HTN

A 
Hx of symptoms of CHF
Hx or symptoms of CVD
Hx of diabetes
Hx of cholesterol issues
Family Hx of premature heart attack or stroke
Meds (all)
Smoking, alcohol, and drug history
56
Q

Diagnosis HTN

A

Two separate measurments of BP at least 5 mins apart in the same arm

57
Q

Causes of HTN

A

95-98 is essential HTN
The rest is secondary due to sleep apnea, chronic renal disease, renovascular causes, drug-induced causes, pheochromocytoma, primary aldosteronism, chronic steroid use, Cushing’s syndrome, thryoid and parathryoid disease, and coarctation of the aorta.

58
Q

Proper BP measurement technique

A

The arm should be supported at heart level. The length of the bladder of the cuff should be at least 80% of the arm circumference and the width of the cuff must be at least 40% of the arm circumference.

59
Q

Important elements of the PE in patients with HTN

A

BMI, fundoscopic eye exam, bruits, palpation of the thyroid gland, lung exam, heart exam, abdominal exam, LE exam, neuro exam

60
Q

True about Thiazide diuretics

A

Hydrochlorothiazide is the most cost-effective antihypertensive drug
Thiazides may affect electrolyte levels
Thiazide diuretics should be avoided in patients with a history of gout
Thiazide diuretics may cause elderly patients to become incontinent of urine

61
Q

Lifestyle modifications that have been shown to directly reduce BP

A
  1. Weight reduction
  2. DASH eating plan
  3. Dietary sodium reduction
  4. Physical Activity
  5. Moderation of Alcohol consumption
62
Q

When to initiate ASA in HTN patients

A

ASA thereapy in men 45-79 years to reduce the risk of MI. Women 55-79. The benefit of decreased riks from those outcomes must be weighed against an increased threat of GI hemmorrhage.

63
Q

JNC 8 recommendations to Treat HTN

A
  1. Implement lifestyle interventions (B)
  2. Set blood pressure goal and initiate blood pressure lowering-medication based on age, diabetes, and CKD
  3. If the blood pressure is still not at goal, JNC 8 next recommends selecting a drug treatment titration strategy
    Always avoid adding ACEI and ARB together
64
Q

Independent risk factors for CHD

A

HDL cholesterol <40, Diabetes, smoking, Hx of CHD in first degree relative, sedentary lifestyle, obesity

65
Q

Main Causes of Palpitations

A
  1. Cardiac arryhythmias
  2. Structural heart disease
  3. Psychosomatic disorders
  4. Systemic causes
  5. Effects of medical or recreational drugs
66
Q

Pain characteristics against angina

A

Pleuritic pain, pulsating pain, positional pain, palpation reproduced pain

67
Q

Low Back Pain

A

(Mechanical97%)Prolonged sitting, with truck driving having the highest rate followed by desk jobs. Deconditioning. Suboptimal lifting and carrying habits. Obesity is a possible risk factor.
Causes - Lumbar strain/sprain (70%), Age related degenerative joint changes in the disks and factes, herniated disks, osteoporotic fracture, spinal stenosis
Epidemiology - LBP is the 5th most common reason for all doctor visits. In the US, lifetime prevalence of LBP is 60-80, the direct and indirect costs are 100 billion. Most LBP resolves in 2-4 weeks.

68
Q

Chlamydia

A

Most common STD bacterial.
Risk factors - Age - women and men aged 24 and younger, hx of chlamydial or other STD, new or multiple sexual partners, inconsistent condom use, sex for money, african american and hispanic pops
Insidious and asymptomatic
Women may develop urethritis, cervicitis, PID, infertility, ectopic pregnancy, chronic pelvic pain
Pregnant women - miscarriage, premature rupture of membranes, preterm labor, low birth weight, infant mortality

69
Q

USPSTF chlamydia screening

A

(A)All sexually active non-pregnant young women aged 24 and younger, non-pregnant women age 25 and older at increased risk (chlamydia, gonorrhea, hep B, HIV, and syphilis(
(B) All pregnant women aged 24 and younder (chlamydia, gonorrhea, hep B, HIV, syphilis) Pregnant women age 24 and older at increased risk (see previous)
Advises against screening women age 25 and older if not at increased risk, regardless of pregnancy status
Insufficient evidence for or against screening men

70
Q

Immunizations for pregnancy

A

If a live, attenuated vaccine (MMR, Rubella, or Varicella) is administered wait 3 mos for a pregnancy, could do if patient is having unprotected sex as pre-conception visit
Pneumococcal vacc if high risk
Influenza

71
Q

Folic Acid supplement

A

Planning 400-800 mg
1 mg in patients with epilepsy or diabetes
4 mg in patients with previous neural tube defect

Family Med (1 decks)

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