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Primary Care III > Module 1 > Flashcards

Module 1 Flashcards

1
Q

Osteoarthritis (OA), also known as

A

degenerative joint disease (DJD) or “wear and tear” arthritis, is the most common articular disease in adults older than age 45. It is the most widespread form of arthritis and is a significant cause of functional impairment, chronic pain, and disability in the older population.

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2
Q

OA risk factors

A

In addition to age, risk factors include genetics, female sex, joint injury, past trauma, advancing age, obesity, and mechanical stress

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3
Q

Principal sites for OA are

A

the distal interphalangeal (DIP) joints, the proximal interphalangeal (PIP) joints, and the carpometacarpal (CMC) joint of the thumb in the hand; the first metatarsophalangeal or great toe joint; and the hips, knees, and cervical and lumbar spine.

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4
Q

OA symptoms

A

Osteoarthritis affects the distal interphalangeal joints (Heberden’s nodes) and PIP joints (Bouchard’s nodes) and presents with swelling, stiffness, pain, and deformity.

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5
Q

RA symptoms

A

usually presents as bilateral pain, swelling, and stiffness of the metacarpophalangeal and PIP joints with characteristic deformities and spares the DIP joints. Generally, other systemic complaints will occur, and joints other than just those in the hand will be affected as well

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6
Q

OA subjective presentation

A

slowly developing, localized gradual pain in affected joints
early morning stiffness which subsides after 30 mins “gel phenemenon”

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7
Q

OA objective presentation

A

minimal or no swelling of affected joints
tenderness on direct palpation
reduced passive/active ROM
crepitus
often asymmetrical

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8
Q

OA DI

A

Primarily clinical dx
Can use plain XR to r/o other condition- may reveal bony cysts, sclerosis, asymmetrical joint space narrowing

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9
Q

OA tx focus

A

Control pain
Manage symptoms
Maximize functional independence/mobility
minimize disability

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10
Q

core tx for all OA pts

A

land based exercise
strength training
weight management
water based exercise
self management
education

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11
Q

non pharm OA tx

A

Education
weight loss
physical therapy, OT
heat, ice, US
accupuncture, supplements

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12
Q

OA hand pharm tx

A

*Topical capsaicin

*Topical NSAIDs

*Oral NSAIDs

*Tramadol

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13
Q

knee OA pharm tx

A

*Acetaminophen

*Oral NSAIDs

*Topical NSAIDs

*Tramadol

*Intra-articular corticosteroid injections

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14
Q

hip OA pharm tx

A

*Obesity management (moderate evidence)

*Nonnarcotic management (strong evidence): oral NSAIDs improve short-term pain function

*Physical therapy (strong evidence)

*Intra-articular corticosteroid injections (strong evidence)

*Mental health disorder (moderate evidence): management of depression, anxiety, and psychosis impact pain relief, function, and ADL

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15
Q

tramadol contra

A

etoh, hypnotics, other narcotics, SSRI

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16
Q

steroid injection OA

A

knee, hip if under fluro
lidocaine typically mixed with steroid
rest joint x1 day, limit activity for 2-3 days
no more than 3-4/yr
can accelerate joint deterioration, increase risk of avascular necrosis

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17
Q

OA most affective sx intervention

A

total joint replacement

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18
Q

Osteoporosis is a

A

generalized skeletal disorder characterized by normal bone mineralization but low bone mass (bone mineral density [BMD]) and disruption of the bony architecture, both of which result in an increased risk of fractures

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19
Q

osteoporosis clinical manifestations

A

vertebral, hip fractures

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20
Q

osteomalacia

A

, which denotes a decrease in actual bone mineralization

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21
Q

of women older than 50 in USA who will experience hip, spine, wrist fracture

A

4 in 10

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22
Q

Women have a two to four times greater lifetime risk of sustaining an osteoporotic fracture than men do because

A

of the loss of BMD following the cessation of ovarian estrogen production at menopause

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23
Q

most rapid bone loss women age

A

decade after menopause

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24
Q

risk for repeat fracture if already had one

A

5x

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25
Q

dietary risk factor for osteoporosis

A

lack of adequate calcium intake throughout life

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26
Q

osteoporosis risk factor

A

female
smoking
low calcium intake
sedentary lifestyle
long term steroid use
testosterone deficiency

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27
Q

only “early” symptom of osteoporosis

A

gradual development of upper/mid thoracic back pain associated with activity or long periods of standing/sitting

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28
Q

vertebral compression fracture presentation

A

sudden, severe onset of pain, point tenderness, “dowagers hump”

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29
Q

osteoporosis risk assessment tools

A

SCORE, FRAX

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30
Q

osteoporosis screening

A

DEXA- utilize Z scores and T scores
BAP (bone alkaline phosphatase) most commonly available serum indicator of osteoblastic activity

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31
Q

Medicare-approved indications for BMD testing include

A

(1) estrogen-deficient women at risk for osteoporosis, (2) patients with vertebral abnormalities, (3) patients receiving or needing to be on long-term glucocorticoids, (4) patients with primary parathyroidism, and (5) patients being monitored for response or efficacy of an approved osteoporosis drug therapy.

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32
Q

osteoporosis management goals

A

prevent fractures
stabilize/improve bone mass
maximize physical functioning
relieve symptoms

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33
Q

osteoporosis lifestyle management

A

smoking cessation
moderation of etoh
weight bearing exercise
adequate calcium, vitamin D

eliminate fall hazards in home

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34
Q

calcium, vitamin D intake daily for osteoporosis

A

calcium 1200mg daily– however best source is from dietary sources
800 iu vitamin d

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35
Q

type of calcium suggested for osteoporosis

A

calcium carbonate less expensive, more easily absorbed with meals

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36
Q

first line pharm tx osteoporosis

A

bisphosphonates

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37
Q

bisphosphonate limitations

A

pharm therapy for 5 years with no bone density monitoring

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38
Q

bisphosphonate side effects

A

irritate upper GI mucosa
must be taken whole in the morning with glass of water before other food/drink, remain upright x30 minutes

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39
Q

repeat BMD testing for tx response every

A

2 years

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40
Q

obesity associated comorbidities

A

ted public health problems. It is associated with multiple comorbidities, including an increased risk of cancer, cardiovascular disease, disability, diabetes mellitus, gallbladder disease, high blood pressure, osteoarthritis, sleep apnea, and cerebrovascular accident (stroke).

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41
Q

two types of obesity

A

central (apple shaped)
lower body (pear shaped)

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42
Q

Patients with central obesity have excessive body fat in the abdomen and flank areas and are at a greater risk for

A

type 2 diabetes mellitus, coronary artery disease (CAD), stroke, and early death,

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43
Q

% of adults overweight or obese

A

70.2%

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44
Q

overweight BMI

A

25-29.9

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45
Q

obesity class 1 bmi

A

30-34.9

46
Q

obesity class 2 bmi

A

35-39.9

47
Q

obesity class 3 bmi

A

> 40

48
Q

extragenetic causes of obesity

A

cultural/environmental factors
suboptimal nutrition/physical inactivity
disrupted sleep cycle
med side effect
stress
neuro dysfunction
viral infection
gut microbiome alterations

49
Q

cancer risk increase obesity males

A

colon, rectal, prostate

50
Q

cancer risk increase obesity females

A

uterine, gallbladder, biliary tract, breast, ovarian

51
Q

most common genetic syndromes with obesity

A

Prader-Willi syndrome
Bardet-Biedel syndrome

52
Q

obesity subjective symptoms

A

fatigue, decreased energy, weakness, joint pain, SOB, daytime sleepiness, depression

53
Q

bmi not accurate in

A

muscular individuals

54
Q

methods to measure for central obesity

A

waist circumference measurment
calculate waist-hip ratio

55
Q

obesity labs

A

TSH, glucose, Hga1c, FLP, liver function, alk phos, bili, vitamin D, CBC

56
Q

Metabolic syndrome is a constellation of risk factors including

A

hypertension, hyperlipidemia, insulin resistance, and overweight/obesity that significantly increases an individual’s risk of cardiovascular disease and diabetes mellitus

57
Q

tx obesity

A

combo of diet, exercise, behavioral intervention

58
Q

weight loss goal obesity

A

10% decrease in weight over 6 months

59
Q

weight loss calorie deficit

A

500-750 calorie/day deficit

60
Q

obesity pharm management

A

orlistat
lorcaserin
phentermine
contrave
saxenda

61
Q

obesity surgery

A

BMI over 40 or BMI over 35 with comorbid conditions
must fail conventional weight loss therapies

62
Q

most common obesity surgery

A

roux-en Y gastric bypass

63
Q

gout

A

metabolic disease produces inflammatory arthritis

64
Q

risk factor gout

A

male
use of diuretics

65
Q

hyperuricemia definition

A

uric acid above 7 in men
6 in women

66
Q

Most individuals (90%) with gout have

A

inappropriate underexcretion of uric acid.

67
Q

mechanisms that trigger acute attack of gout

A

trauma
surgery

68
Q

gout stages

A

asymptomatic
acute phase
intercritical
chronic tophaceous

69
Q

acute phase

A

inflammatory phase
extremely painful joints, red/swollen
elevated wbc, temp, serum uric acid

70
Q

intercritical phase

A

interval b/tw phases
asymptomatic

71
Q

chronic tophaceous

A

results from recurrent attacks
restrict movement of affected joints

72
Q

gout subjective

A

pain tenderness erythema swelling of affected joints
mono articular, joint most frequently affected first joint of big toe
excruciating pain that awakens pt at night
not relieved with rest

73
Q

gout objective

A

affected area warm or hot to touch
pain on palpation
limited rom
podagra most affecte

74
Q

gout testing

A

serum uric acid
definitive test= microscopic observation of urate crystals in aspirated joint fluid

75
Q

gout tx initial

A

NSAIDs- indomethacin or naproxen, steroids, rest,

76
Q

colchicine

A

effective to terminate acute attack of gout if given within 36 hours of onset of symptoms
1-1.2mg given at first sign of attack, followed by 0.5-0.6 every 1 until pain relieved

77
Q

meds to lower uric acid levels

A

probenecid
allopurinol
febuxostat
not to be started during or within 1 month of acute attack

78
Q

dietary modifications gout

A

avoid purine rich foods (meats, seafood, yeast, beer, beans)
adequate fluid intake
moderate etoh

79
Q

physical activity during acute gout attack

A

restricted, bedrest x24 hours

80
Q

linea nigra

A

, a brownish black pigmented vertical stripe along the midline skin,

81
Q

The uterus increases in weight from approximately

A

70 g at conception to almost 1,100 g at delivery, when it accommodates from 5 to 20 L of fluid

82
Q

anteverted

A

(forward-leaning)

83
Q

retroverted

A

backward leaning

84
Q

retroflexed

A

backward bent

85
Q

chadwick sign

A

vagina and cervix blue color

86
Q

leukorrhea of pregnancy

A

normal vaginal secretions become thick, white and more profuse

87
Q

hegar sign

A

palpable softening of cervical isthmus

88
Q

breast changes during pregnancy

A

moderately enlarged
more nodular
nipples larger, more erectile
darker areola, more pronounced montgomery glands

89
Q

EDD

A

add 7 days to LMP, then add 9 months

90
Q

Gravidity refers to

A

the number of times that a woman has been pregnant,

91
Q

parity is the

A

number of times that she has given birth to a fetus to a viable age (≥24 gestational weeks), regardless of whether the child was born alive or was stillborn.

92
Q

prenatal visits

A

initial visit
q 4 weeks until 28 weeks
q2 weeks until 36 weeks
q1 week until delivery

93
Q

weight loss due to nausea/vomiting that exceeds

A

5% is considered excessive, aka hyperemesis gravidarum

94
Q

Gestational hypertension

A

is systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg first documented after 20 weeks, without proteinuria or other evidence of preeclampsia, that resolves by 12 weeks postpartum.

95
Q

mammary souffle

A

increased blood flow through breast vasculature cause
strongest in 2nd or 3rd intercostal space

96
Q

fetal movement

A

can be felt externally @24 weeks
by patient at 18-24 weeks

97
Q

if fundal height 4 cm larger than expected consider

A

multiple gestation
large fetus
extra amniotic fluid
uterine leiomyoma

98
Q

if fundal height 4 cm smaller than expected consider

A

low level amniotic fluid
missed abortion
IUGR
fetal anomaly

99
Q

Adnexal tenderness or masses early in gestation

A

require ultrasound evaluation to rule out ectopic pregnancy. Acute pelvic inflammatory disease is rare in pregnancy, especially after the first trimester, because the adnexa are sealed by the gravid uterus and mucus plug.

100
Q

unilateral severe edema with calf tenderness

A

warrants prompt eval for DVT

101
Q

Leopold maneuvers

A

used to determine fetal position in maternal abdomen in 2nd trimester, greatest accuracy after 36 weeks

102
Q

pregnant pt to avoid these foods

A

Unpasteurized milk and foods made with unpasteurized milk
Raw and undercooked seafood, eggs, and meat
Refrigerated paté, meat spreads, and smoked salmon
Hot dogs, luncheon meats, and cold cuts unless served steaming hot

103
Q

weight gain in pregnancy

A

determined by BMI prior to pregnancy

104
Q

acog physical activity recommendations

A

<30 min moderate exercise most days of week unless contraindications

105
Q

leading cause of preventable mental disability in USA

A

fetal alcohol syndrome

106
Q

vaccines safe during pregnancy

A

pneuococcal
meningococcal
hep B
inactivated flu

107
Q

vaccines not safe during pregnancy

A

mmr
live attenuated flu
polio
zoster
varicella

108
Q

prenatal lab screening

A

ABO and Rh (D) type
RPR
bacteruria
hep b
HIV
iron deficiency
gestational diabetes screening

109
Q

diabetes screening test in pregnancy

A

50g oral glucose tolerance test
glucose checked 1 hour after glucose load, threshold of 130-140. If positive, then must do 100g 3 hour diagnostic OGTT
screen 24-28 weeks

110
Q

prenatal vitamins

A

folate, b12
iron

Primary Care III (7 decks)

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