Med - u cases Flashcards
1
Q
Patient has increased risk of breast cancer if __________ degree relative has had it
A
First degree relative
2
Q
Does the USPTF recommend self breast exams?
A
No
3
Q
Cervical cancer screening guidelines
A
Start at 21 years
21-29 every 3 years
30-65 every 5 if co tested with HPV or every 3 with cytology alone
Stops at 65 if 10 years of normal prior
4
Q
Characteristics of good screening test
A
Highly sensitive and specific
Detect disease in asymptomatic phase
Minimal risk
Reasonable cost
Acceptable to patient
Available treatment
5
Q
Is ovarian cancer screening recommended?
Skin cancer?
Lung?
A
No
No
Yes, 55-80 with 30 pack year hx
6
Q
Tetanus immunization adults
A
Single dose Tdap instead of Td. 19-64
7
Q
Calcium recommendation
Pre and post menopause
A
Pre - 1000 mg daily
Post - 1200
8
Q
Osteoporosis screening
A
Women over 65
DEXA
9
Q
Bethesda System for Reporting cervical cytology
3 categories
A
Specimen adequacy
General categorization of results
Interpretation of results - ASC, LSIL, HSIL
10
Q
Mammography has more ______ in young women
A
False negatives
Dense breast tissue = harder to find lesions
11
Q
Recommended screening for ASCUS
A
3 years with HPV co testing
12
Q
RISE mnemonic for preventive visits
A
Risk factors
Immunization
Screening tests
Education
13
Q
ASCVD screening recs
A
Every 4-6 years
20-79 years who are free of ASCVD
14
Q
A or B screening recs in 55 year old male smoker
A
Colorectal cancer Obesity DM Lipid disorders Tobacco HTN Alcohol misuse Lung cancer - smokers Hep C - born 1945-1965
15
Q
Three C of addiction
A
Compulsion to use
Lack of Control
Continued use despite adverse outcomes
16
Q
Five As of counseling for behavior change
A
Ask or address behavior Assess for interest in change Advise on methods Assist with motivation Arrange follow up
17
Q
BMI
A
Weight in kg/ height in meters (squared)
18
Q
BMI categories
Below 18.5 =
18.5-24.9
25-29.9
30 and above
A
Underweight
Normal
Overweight
Obese
19
Q
Annual quit rate for smokers without medical intervention
A
2-3%
Oral meds increase 1.5 to 3x the placebo quit rate
20
Q
Appropriate steps for managing high risk ASCVD include
A
Aspirin and high intensity statin
21
Q
Common causes of insomnia in the elderly
A
Environment Sleep apnea Restless leg Depression/anxiety Cardio respiratory disorders Pain/pruritus GERD Hyperthyroidism
22
Q
Two recommended dementia screen tools
A
MMSE
MINI COG
23
Q
Depression is identified less or more in Hispanics than whites?
A
Less
24
Q
Lab eval of depression/fatigue
A
CMP
TSH
CBC
25
Most common manifestation of Graves
Primary symptoms of graves related to?
Eyelid retraction + Exopthalmos
Corneal irritation from eyelid retraction
26
High radioactive iodine uptake
```
Graves
Multinodular goiter
Toxic solitary nodule
TSH secreting pituitary tumor
HCG secreting tumor
```
27
Low Radioactive iodine uptake
```
Sub acute thyroiditis
Silent thyroiditis
Iodine induced
Exogenous thyroxine
Struma ovarii
Amiodarone
```
28
Most common med for hyperthyroid
Dangerous side effect
Methimazole
Agranulocytosis
29
Test to obtain before radioactive iodine
Pregnancy test
30
Diabetes screening
Asymptomatic adults with BP >135/80
31
Dx criteria for diabetes
Random glucose over 200
Fasting > or equal to 126
A1c of 6.5 or greater
OGTT is more sensitive than fasting
Need to be confirmed on a different day
32
Optimal range for blood glucose
<120 fasting
<180 post prandial
33
USPSTF recommendations for aspirin in diabetics
50-59 with >10% 10 year ASCVD risk score
60-69 with >10%
34
Wagner ulcer grading
| 1-5
1 superficial
2 extension into ligament, tendon, joint capsule, fascia
3 deep with abscess or osteomyelitis
4 partial gangrene
5 extensive gangrene
35
Main causes of palpitations
```
Arrhythmia
Structural heart disease
Psychosomatic
Systemic
Medical or recreational drugs
```
36
USPSTF chlamydia screening recs
All sexually active women 24 and younger
25 and over if high risk
37
Folic acid rec for women capable of becoming pregnant or who are planning to
400 to 800 micrograms daily
1 mg for diabetics or epileptics
4 mg for those who bore a child with NTD
38
Naegeles rule
Add a year
Subtract 3 months
Add 1 week
=Estimated date of delivery
39
First trimester Estimation of gestational age method
Accuracy
Crown rump length
+/- 1 week
40
HEEADSSS adolescent interview
```
Home
Education
Eating
Activities
Drugs
Sex
Suicide
Safety
```
41
Beta hcg level to detect intrauterine pregnancy
How often does it double?
>1500
Should double every 48 hours in normal pregnancy
42
Moderate persistent asthma treatment
Step?
Step 3
Low dose inhaled corticosteroid + long acting Beta agonist (preferred)
OR
Medium dose inhaled corticosteroid alone
43
19-64 with chronic heart, lung, liver disease or diabetes or alcoholism
Pneumonia vax?
PPSV 23
44
Recommended pregnancy weight gains according to BMI
```
18-25 = 25-35lbs
25-30 = 15-25 lbs
30+ = 11-20lbs
```
45
Placenta previa is more likely to resolve if detected when?
Earlier in pregnancy
46
3 hour OGTT positive if?
2 or more of:
Fasting > 95
1hr > 180
2hr > 155
3hr > 140
47
Only type of IUD approved for post partum?
Copper
48
Macular
Flat lesion
Less than 1cm
Basically a change in color of the skin
49
Patch
Flat lesion
Greater than 1cm
50
Papule
Solid raised lesion
Distinct borders
Less than 1cm
51
Plaque
Solid, raised, flat topped lesion
Greater than 1cm
52
What two tinea require systemic treatement?
Capitis and Unguium
53
Most common symptoms of menopause
Hot flashes
Vasomotor symptoms
54
Most women should consume ______ mg calcium and _____IU vitamin D daily
1200
800-1000
55
When to initiate pharmacological tx for migraines
At least 6 headache days per month
4 headaches days with some impairment
At least 3 headaches with severe impairment
56
of episodes needed for
Migraine dx
Tension dx
Cluster dx
5 migraine
10 tension
5 cluster
57
Migraine prophylaxis
Beta blockers
TCA's
Divalproex, Topirimate
58
Center criteria
One pt each for:
```
Tonsillar exudate or erythema
Anterior cervical adenopathy
Cough absent
Fever present
3-14 years +1
15-45 = 0
45 and over = -1
```
59
Centor 2-3
Rapid strep
60
Centor 4-5
Treat with antibiotics
61
Two most common complications of influenza
Bacterial pneumonia
Otitis media
62
Strep treatment 1sr line
DOSAGE
Amoxicillin
90 mg/kg/day - 3 doses
63
Diabetes screening in children
All children with risk factors and >85% of BMI
All children >95% of BMI without risk factors
64
Children younger than 7 with >95%ile BMI and NO secondary complications should______
Maintain their weight
With complications should drop to <85%ile
65
Cholesterol guidelines for kids
<170 total
<130 LDL
66
80% of strokes caused by _________
Thrombosis
67
Hours/day healthy infant cries
2 weeks = 2 hours
6 weeks = 3 hours
3 months = 1 hour
68
Clinical staging of colorectal cancer
Tests
CT abd pelvis
Chest X-ray
CEA maybe
69
Most common type of testicular tumor
Germ cell
70
Two types of germ cell tumors
Seminomatous
Non-seminomatous - embryonal, mixed, teratoma, yolk sac, choriocarcinoma
71
Non germ cell tumors?
Leydig
Sertoli
72
Major benefit of quitting smoking in COPD occurs when?
In the first year
73
FEV1/FVC ratio diagnostic of COPD
<5th %ile or < 70%
74
COPD levels
Mild
Moderate
Severe
Very severe
FEV1
<80%
50-79%
30-49%
<30%
75
Dementia with Lewy body
Differences from Alzheimer's
Visual hallucinations
Parkinsonism
76
Cholinesterase inhibitors for dementia
Donepezil
Rivastigmine
Tacrine
Galantamine
77
Average cervical dilation speed
Multi
Nulli
2cm/hr
1cm/hr
78
Failure to progress
No cervical change for 2 hours in active phase
Fetal presenting part fails to descend in the pelvis after 2 hours (3 if epidural)
79
Cardinal movements of labor
```
Engagement
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion
```
80
4 T's of Post Partum Hemorrhage
Tone
Trauma
Tissue
Thrombin
81
Category III fetal tracing
No variability +
Bradycardia OR
Recurrent late deceleration OR
Recurrent variable decels OR
Sinusoidal HR pattern
82
SGA
Weight below 10th %ile
83
Microcephalic
Head circumference less than 10th%ile
84
Average cal/kg/day requirement of
Term
Pre term
Very low birth weight
100-120
115-130
Up to 150
85
Moro reflex disappears by
4 months
86
Over first 5 years
Number of doses of
```
DTaP
IPV
HIB
PCV13
MMR
VARICELLA
ROTA
HEP A
HEP B
```
```
5
4
3-4
4
2
2
2-3
2
3
```
87
Double birth weight by?
Triple by?
Double birth length by?
4-5 months
1 year
4 years
88
```
6 month developmental
Gross
Fine
Language
Social
```
Rolls, sits unsupported, no head lag
Reaches for objects, looks for dropped items
Turns toward voice, babbling
Feeds self, stranger recognition
89
12 month developmental
Gross
Fine
Language
Social
Stands alone, many walk
Neat pincer grasp
Mama and dada, 1-2 other words
Hands parent a book to read, points to things they want, imitates activities, plays ball
90
Most frequently diagnosed neoplasm in infants
Neuroblastoma
91
3 year old developmental
Social
Communication
Cognitive
Physical
Brushes teeth with assistance, feeds self
2-3 world sentences, 75% understandable
Name and use of cup, ball, crayon, spoon
Tower of 6-8 cubes, throws a ball overhand, tricycle, copies a circle
92
4 year old developmental
Social, communication, cognitive, physical
Knows gender and age, friendly with other kids, fantasy play
First and last name, most speech understandable
Names colors, board games, draws person with 3 parts, copies a cross
Hops on one foot, balances for 2 secs, pours, cuts, mashes food, brushes teeth
93
5 year old developmental
Social, communication, cognitive, physical
Listens and attends, tell difference between real and make believe, sympathy and concern for others
Tells simple story, proper tense and pronouns, counts to 10
Draws a person with 6 parts. Copies square, some letters and numbers
Balances on one foot, hops and skips, mature pencil grasp, undresses/dresses with minimal assistance
94
4 groups benefitting from statin therapy
Current ASCVD
LDL >190
DM type I or II age 40-75
ASCVD Risk > 7.5%
