Office-Osteoporosis, Obesity, Rape, IPV

Question 1

What does Dexa scan stand for?

Answer 1

Dual energy x-ray absorptiometry

Question 2

What is the Dexa scan

Answer 2

Tool used to measure the BMD of the hip and spine to assess for bone loss and risk of fracture

Question 3

What is a normal T score?

Answer 3

> /= -1 SD below mean young adult peak bone mass

Question 4

What is a T score for osteopenia?

Answer 4

Between -1 to -2.5 below mean young adult peak bone mass

Question 5

What is a T score for osteoporosis?

Answer 5

</= -2.5 SD below young adult peak mass

Question 6

What is a T score?

Answer 6

Compares the individuals BMD measurement at the hip and spine with the peak mean BMD of a normal young adult

Question 7

What is a Z score?

Answer 7

Standard deviations between individual BMD and mean BMD from reference population of the same age, sex,race

Question 8

What bones should be scanned for a Dexa scan?

Answer 8

Central bones like hip and spine

Question 9

When does the screening for dexa scan begin?

Answer 9

1. Age 65
2. Postmenopausal with 1 or more risk factors for osteoporosis
3. FRAX index of 8.4% or greater

Question 10

How often do you perform dexa scan?

Answer 10

q2 years

Question 11

What are risk factors for osteoporosis?

Answer 11

Personal history of fracture
Frail(low BMI)
First degree relative with fracture
Caucasian race
Current cigarette smoker
Low calcium intake
Poor eyesight
Inadequate physical activity
Estrogen deficiency
Alcoholism
medications
Medical conditions

Question 12

What is the normal rate of bone loss?

Answer 12

Premenopausal: 0.5% per year
Postmenopausal: 5% per year

Question 13

What is the workup for osteoporosis?

Answer 13

CBC
CMP
VItamin D level
24hr urine calcium
TSH
PTH

Question 14

What is the FRAX index?

Answer 14

Fracture risk screening tool that predicts the risk for an osteoporotic fracture in the next 10 years

Question 15

What age should FRAX index be used for?

Answer 15

> 40 years old

Question 16

What does FRAX index tell you?

Answer 16

Decision to treat for osteopenia
Decision to do DEXA scan on patient <65 years old

Question 17

What would make you do a Dexa scan on someone younger than 65?

Answer 17

FRAX index score of >8.4%
Postmenopausal with 1 or more risk factors

Question 18

When do you treat for osteoporosis?

Answer 18

T score of -2.5 without risk factors
T score of -1.0 or below and FRAX score >/= 3% for hip fracture or >/= 20% for major fracture

Question 19

How can you prevent osteoporosis?

Answer 19

Weight bearing exercise
Sunlight
Calcium intake
Vitamin D
Bisphosphonates
HRT
SERMs
Calcitonin

Question 20

What is the recommended daily intake of calcium per day?

Answer 20

9-18= 1300
19-50= 1000
>50= 1200

Question 21

What is the definition of obesity?

Answer 21

BMI>/= 30

Question 22

Class 1 obesity?

Answer 22

BMI=30-35

Question 23

Class 2 obesity?

Answer 23

BMI= 35-40

Question 24

Class 3 obesity?

Answer 24

BMI= >/=40

Question 25

What is the management of obesity in the office?

Answer 25

See patient monthly
Counsel on nutrition/exercise
Behavioral support
Medical treatment if BMI >30
Surgical intervention if BMI >40 or >35 with medical risks

Question 26

What is the recommended exercise for obesity?

Answer 26

Minimum of 30min brisk walk every other day

Question 27

How do you counsel a patient regarding spouse abuse?

Answer 27

1. Screen and counsel at each annual exam, New OB visit, each trimester
2. Advise it exists among all socioeconomic groups and is common
3. Use framing statement
4. Assure confidentiality
5. Allow patient to call IPV hotline from office phone
6. Document pertinent info in case if court proceedings
7. Not mandatory to report IPV
8. Do not alienate or force information on patient
9. Be supportive
10. Assist patient in developing a safety plan

Question 28

What is the incidence of rape?

Answer 28

1:5

Question 29

How do you screen women for history of sexual assault?

Answer 29

Screen all
Ask direct questions, non judgmental
Validate the patient
Evaluate, educate and refer

Question 30

When should a rape exam be performed?

Answer 30

48-72hrs from event

Question 31

What comprises a rape exam?

Answer 31

History
Physical
Tests (scalp hair, saliva, pubic hair)
NAATs for chlamydia, gonorrhea, trich
Blood work( syphillis, HCG, HIV, hepatitis
Vaginal and rectal swabs
Fingernail scrapings
Stains on clothes
Utilize photography
Maintain chain of custody of evidence
Emergency contraception
ppx STI treatment
Follow up in 6 weeks

Question 32

What is the prophylactic STI treatment for rape victim?

Answer 32

1. 500mg ceftriaxone IM
2. Doxycycline 100mg BID for 7 days
3. Flagyl 500mg BID for 7 days

Question 33

What medications can cause osteoporosis?

Answer 33

A= aromatase inhibitors, anticoagulation, anticonvulsants
B= Barbituates
C= Chemotherapy agents
D= Depo
G= Glucocoriticoids, GNRH agonist/antagonists
L= Lithium

Question 34

What are medical conditions that can cause osteoporosis?

Answer 34

HIV/AIDS
Hyperparathyroidism
Thyroid disease
Diabetes
Multiple myeloma
Hypocalcemia

Question 35

What does evaluation for osteoporosis include?

Answer 35

Clinical examination (medical history, physical exam, height measurement)
Risk assessment
BMD testing

Question 36

What are the criteria to diagnose osteoporosis?

Answer 36

1. T score of -2.5 or lower
2. History of fragility fracture
3. Low bone mass + increased risk of fracture