Primary Care Flashcards

1
Q

Vitamin D requirements by age

A

(National Osteoporosis Foundation)
50yrs and younger- 400-800IU/day
51yrs and older- 800-1000IU/day

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2
Q

Calcium requirements by age

National Osteoporosis Foundation

A

50yrs and younger- 1000mg

51yrs and older- 1200mg

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3
Q

Folate requirements

A

0.4mg/400mcg folic acid per day; if a history of neural tube defect then can give higher dose such as 4mg 1 mo before trying to get pregnant until 2-3 months of pregnancy

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4
Q

Iron requirements by age

A

14-18yrs- 15mg/dL a day
19-50yrs- 18mg/dL a day
over 51yrs- 8mg/dL a day

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5
Q

Sodium intake for African Americans and HTN/DM/kidney disease

A

no more than 1500mg per day

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6
Q

Physical activity recommendations weekly

A

150-300min of moderate or 75-150 vigorous per week

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7
Q

Screening for alcohol use

A

AUDIT-C and Single Alcohol Screening Question

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8
Q

LAIV- live flu vaccine, who can you give it to?

A

Only give in healthy, non-pregnant, between ages of 2-49

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9
Q

HPV vaccine dosage schedule if younger than 15?

A

administer 2 doses with second dose 6-12mo after first dose

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10
Q

New 2017 HTN Guidelines

A

Normal: less than 120/80
Elevated: 120-129/80 or less
Stage 1: 130-139/80-90
Stage 2: greater than 140/90

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11
Q

Cholesterol levels

A

Total: less than 200
LDL: less than 100
HDL: less than 40 is too low, greater than 60 is cardio protective
Triglycerides: less than 150

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12
Q

What is the first line treatment for elevated and stage 1 HTN? What is the second line treatment for stage 1 HTN?

A

Lifestyle modifications

Second line treatment for stage 1 is medication

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13
Q

What is the first line treatment for stage 2 HTN?

A

Start on two meds from two different classes;

ACE and ARBs are contraindicated in pregnancy; offer POPs or LARCs as contraception (no estrogen with uncontrolled HTN)

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14
Q

HPV vaccination dosage schedule if >15 years old?

A

Give 3 doses with second dose 2 months after first and third dose 6 months after first

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15
Q

What is the recommended age range to begin HPV vaccinations?

A

11-12 years old with 9 years old being the youngest

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16
Q

What are the recommendations for colorectal cancer screening (ACS)?

A

Adults >45 years should undergo regular screening with either a high-sensitivity stool test or structural exam (colonoscopy, flexible sigmoidoscopy or CT colonography)

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17
Q

When and for whom do USPTF and ACS recommended lung cancer screening?

A

Individuals 55-74 years old who have risk factors such as 30+ PPD smoking history and still smoking or quit within last 15 years

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18
Q

When is diabetes screening recommended and how frequently?

A

Every 3 years starting at age 45

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19
Q

USPSTF recommends periodic assessment of total cholesterol, LDL and HDL in what age range?

A

40-75 years old

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20
Q

At what age should a woman begin to have bone mineral density testing?

A

65

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21
Q

When is hepatitis C screening recommended?

A

Once for all women born between 1945-1965 unless other risk factors are present

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22
Q

Hepatitis B immunization schedule

A

Three dose series: second and third doses at 1 and 6 months after the first.

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23
Q

What are the recommendations regarding PCV13 and PPSV23 for immunocompetent individuals and which should be given first?

A

One time dose of PCV13 and PPSV23 for all immunocompetent individuals >65 years old, given one year apart and starting with PCV13

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24
Q

Recommendations for varicella vaccination?

A

Recommended for all non-pregnant adolescents/adults without immunity. Given in two doses 4-8 weeks apart

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25
Q

Recommendations for zoster (shingles) vaccination (RZV)?

A

two dose series 2-6 months apart for adults >50 years old

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26
Q

Recommendations for meningococcal vaccination?

A

Recommended initial vaccination at age 11-12 with booster at age 16.
Booster not needed if initial vaccine given at age 16

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27
Q

Bone mineral density T-scores

A

Normal: greater than -1
Osteopenia: -1 to -2.5
Osteoporosis: at or below -2.5

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28
Q

When does Troponin I and T become elevated after an event and how long is it elevated for?

A

3-4 hours after event and is elevated for 7-14 days after event

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29
Q

What is are the first line treatments (2) for allergic rhinitis?

A

Antihistamines and nasal corticosteroids

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30
Q

What are the symptoms of bacterial conjunctivitis and how do you treat it?

A

Mucopurlulent discharge

Broad spectrum topical antibiotic- erthryomycin

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31
Q

What are the symptoms of viral conjunctivitis and how do you treat it?

A

Watery discharge

Cold compresses and lubricants (liquid tears) for comfort

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32
Q

What is the first line treatment for acute otitis media if it does not first resolve spontaneously on its own?

A

Amoxicillin followed by Augmentin if there is an inadequate response

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33
Q

When should you give Augmentin (or Doxycycline if PCN allergic) for sinusitis?

A

If symptoms last >10 days without any improvement, symptoms worsen after 5-6 days after initially improving or high fever >102

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34
Q

What is first line treatment for strep throat (GABHS)?

A

Penicillin V or Amoxicillin

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35
Q

What is the classic triad of symptoms for mono?

A

fever, sore throat and swollen lymph nodes

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36
Q

If a woman has a latent TB infection, what are they treated with and for how long?

A

Isoniazid for 9 months supplemented with Vitamin B 6 (pyridoxine)

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37
Q

If a woman has active TB, what are they treated with and for how long?

A

Isoniazid, rifampin, pyrazinamide for 2 months followed by isoniazid and rifampin for 4 additional months

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38
Q

What is the Rome 3 criteria for IBS?

A

recurrent abdominal pain for at least 3 days per month in the previous 3 months

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39
Q

For pain predominant IBS, what two classes of drugs could you treat it with?

A
Antispasmodic/anticholinergic (Bentyl)
Tricyclic antidepressants (amitriptylin/Elavil)
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40
Q

What is a positive Rovsings sign?

A

RLQ elicited when LLQ is deeply palpated and pressure is released (rebound)

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41
Q

What QI disorder causes early morning awakening, occurs in clusters and is associated with h pylori?

A

Peptic ulcer disease (PUD)

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42
Q

What is the triple therapy that you treat h. pylori with?

A

PPI, amoxicillin and clarithromycin

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43
Q

What does a positive HBV surface antigen (HbsAg) indicate?

A

The person is infectious and has acute and chronic infection

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44
Q

What do IgG antibodies indicate?

A

Previous infection or immunity

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45
Q

What do IgM antibodies indicate?

A

Current infection

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46
Q

What does a positive HBV surface antibody (anti-HBs) indicate?

A

Immunity due to prior infection or vaccination

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47
Q

What is the treatment for a non-pregnant woman with a UTI/cystitis?

A

Trimethoprim-sulfamethoxazole 3-day regimen or nitrofurantoin for 5 days

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48
Q

What is considered ‘recurrent UTIs’?

A

at least 2 culture proven and symptomatic infections in 6 months or 3 in one year.

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49
Q

What is the gold standard to diagnose urolithiasis?

A

CT scan

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50
Q

What is a normal hemoglobin level?

A

greater than 12 g/dL

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51
Q

What are the values for Microcytic anemia and what does it indicate?

A

MCV <80, iron-deficiency, thalassemia trait

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52
Q

What are the values for Macrocytic anemia and what does it indicate?

A

MCV >80, vitamin B12 deficiency, folate deficiency, liver disease, hypothyroidism

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53
Q

What are the values for Normocytic anemia and what does it indicate?

A

MCV 80-100, anemia of chronic disease, sickle cell, renal failure, hemolysis

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54
Q

What level Hct constitutes ‘severe anemia’?

A

Hct less than 25%

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55
Q

True or False….Antiretroviral drugs given in pregnancy to an HIV positive mother reduces vertical transmission rate to fetus?

A

TRUE

56
Q

What CD4 cell count is present with AIDS-PCP?

A

below 200 cells/mm3, normal is 800-1050 cells/mm3

57
Q

What is the purpose of quantitative plasma HIV RNA testing in a person with an established HIV infection?

A

predicts progression of disease by indicating viral load and used to make decisions about initiating antiviral medications and monitoring response to medication

58
Q

What is the purpose of CD4 cell count testing in a person with established HIV infection?

A

indicative of immune status and predictor of disease progression

59
Q

What score is needed on the RA algorithm to classify as RA?

A

total of 6 out of 10 in four categories

60
Q

Morning stiffness in joints lasting longer than 1 hour, fatigue, anorexia, fever, symmetrical soft tissue swelling, lymphadenopathy, and splenomegaly are all symptoms of RA or OA?

A

RA

61
Q

What class of drugs is used to treat RA?

A

DMARDs, can use NSAIDs and corticosteroids for short term management until DMARDs take effect

62
Q

What are the 5 components of metabolic syndrome?

A

abdominal obesity, insulin resistance, elevated triglycerides and low HDL, HTN, and pro-inflammatory state

63
Q

The classic symptoms of diabetes are?

A

3 Ps: polyuria, polydipsia, and polyphagia

64
Q

What are the diagnosis criteria for diabetes? There are four and you only need one of them to make a diagnosis.

A

Fasting glucose: 126 mg/dL or greater
OGTT: 200mg/dL or greater in 2hr/75mg test
HbA1c: 6.5% or greater
Random plasma glucose: 200mg/dL or greater with classic symptoms
All of these must be confirmed on subsequent day unless pt is showing symptoms of hyperglycemia

65
Q

Free T4 and TSH is usually elevated or decreased with Hyperthyroidism?

A

T4 elevated and TSH decreased

66
Q

Free T4 and TSH is usually elevated or decreased with Hypothyroidism?

A

T4 decreased and TSH elevated

67
Q

What are two common pharmacological treatments for hyperthyroidism?

A

PTU and methimazole

68
Q

What disease is commonly associated with hyperthyroidism?

A

Graves disease

69
Q

What disease is commonly associated with hypothyroidism?

A

Hashimoto’s disease

70
Q

What is a common pharmacological treatment for hypothyroidism?

A

Levothyroxine, should measure TSH every 4-6 weeks and adjust treatment

71
Q

What level of TSH indicates treatment needed for hypothyroidism?

A

TSH greater than 10uIU/mL or levels of 5-10 with symptoms

72
Q

Gradual onset of joint pain, joint pain subsides with rest, morning stiffness lasting less than 30min, and asymmetrical joint symptoms are associated with RA or OA?

A

OA

73
Q

RA and SLE can be ruled out as differentials for OA with what symptoms and tests?

A

normal RF/ANAs and inflammation present with symmetrical joint distribution, these are findings in OA not RA and SLE

74
Q

In a post menopausal woman with osteopenia, what test is used to make decisions concerning preventative medication?

A

FRAX algorithm

75
Q

Vertebral fraction is consistent with a diagnosis of osteoporosis along with BMD results. True or False?

A

FALSE. In an older woman, a vertebral fracture is an independent finding to warrant a diagnosis of osteoporosis regardless of BMD results.

76
Q

What are some FDA approved drugs to treat fibromyalgia?

A

Lyrica, SNRIs-Cymbalta

77
Q

What test should be done on a person with new onset of headaches that is over the age of 40 to rule out temporal arteritis?

A

erythrocyte sedimentation rate

78
Q

What 3 classes of medications can be given to someone as prophylactic therapy for migraines?

A

Beta-blockers (propranolol), CCB (verapamil), or anti epileptic meds (valproic acid, depakote, topamax)

79
Q

What is the most common form of headache?

A

Tension

80
Q

Is a migraine headache usually unilateral or bilateral?

A

Unilateral

81
Q

Nausea, vomiting, photophobia, phono-phobia and fatigue are all associated symptoms of which type of headache?

A

Migraine

82
Q

Which type of headache is often nocturnal (waking patient from sleep)?

A

Cluster headaches

83
Q

What 2 classes of medications can be given for chronic tension headaches?

A

TCAs (amitriptyline, nortriptyline) or SSRIs

84
Q

Obstruction of the pilosebaceous follicle is the primary cause of what?

A

Acne

85
Q

What are some contributing/aggravating factors for acne?

A

Hormonal cycles, topical/oral corticosteriods, irritant oils or cosmetics

86
Q

What are two medications that can be prescribed for mild acne?

A

Benzoyl peroxide and retinoic acid derivatives

87
Q

What do you need to educate women to avoid when taking retnioic acid derivatives?

A

UV light, sun and extreme weather

88
Q

What two antibiotics can you prescribe for moderate to severe acne?

A

Doxycycline and minocycline

89
Q

Which drug for severe cystic acne is contraindicated with pregnancy and lactation?

A

Accutane

90
Q

Mild irritants may cause what symptoms (3) in irritant contact dermatitis?

A

Erythema, dryness and fissuring

91
Q

What are ‘classic lesions’ of allergic contact dermatitis?

A

Versicles and blisters on erythematous base

92
Q

What (4) non pharmacologic measures can you recommend for contact dermatitis?

A

Compresses, epsom salt soaks, lubricating ointments and petrolatum

93
Q

Extremely pruritic, erythematous, dry, scaly, excoriated, lichenified patches of skin are characters of which skin condition?

A

Eczema

94
Q

Education to moisturize frequently with a thick heavy moisturizer is for which skin condition?

A

Eczema

95
Q

If eczema is severe and does not respond to steroids or topical immunosuppressants, what can be considered?

A

An oral immunosuppressant

96
Q

Which type of skin cancer is second most common in whites and most common in blacks?

A

squamous cell carcinoma

97
Q

Chronic sun exposure and genetics are possible causes for which type of skin cancer?

A

Basal cell carcinoma

98
Q

Sun exposure or chronic irritation are possible causes for which type of skin cancer?

A

Squamous cell carcinoma

99
Q

What are symptoms of both BCC and SCC?

A

Painless, slow growing lesions that will not heal on sun-exposed area or skin damaged by burns or chronic inflammation?

100
Q

What is an early symptom of malignant melanoma?

A

Pruitis

101
Q

Which type of skin cancer tends to follow the ABCDEs?

A

Malignant melanoma

102
Q

What does ABCDE stand for?

A

Asymmetry, border irregularity, color variations, diameter >6mm and elevation

103
Q

How often is a total cutaneous examination (TCE) recommended for populations with risk factors?

A

Annually

104
Q

Which procedure is a gradual lesion excision using serial frozen section analysis and mapping of excised tissue until tumor free plane is reached and what type of skin cancers is it used for?

A

Mohs microsurgery

BCC and SCC

105
Q

What is tinea/dermatophytosis?

A

A superficial fungal infection caused by dermatophytes and yeasts

106
Q

What three areas is dermatophytosis restricted to and why?

A

Hair, superficial skin and nails

Because dermatophytes require keratin for growth

107
Q

What is tinea capitis and whom is it most common in?

A

Fungal infection on the scalp

Children

108
Q

How are fungal infections transmitted?

A

Via contact with infected persons, fomites (shoes, towels, shower stalls), animals or soil

109
Q

What is a the ‘classic presentation’ of tinea?

A

Central clearing surrounded by an advancing, red, scaly, elevated border

110
Q

What would you see on KOH microscopy if a person had tinea?

A

Hyphae

111
Q

What rash looks like a Christmas tree on the trunk and will go away on its own?

A

Pityriasis rosea

112
Q

What two classes of anti-fungals would you treat tinea corporis, cruis and pedis with?

A

Azoles (lotrimin/monistat) or allylamines (Lamisil/Naftin)

113
Q

A chronic immune mediated disorder with overgrowth of keratinocytes and accompanies inflammation is what skin condition?

A

Psoriasis

114
Q

What 4 prominent features does psoriasis have?

A

Sharply demarcated with clear borders
Erythematous plaque base
Overlapping silvery scales
Removal of scales cause small droplets of blood

115
Q

What is the non-pharmacologic treatment for psoriasis?

A

Sun exposure or UV B radiation

116
Q

Steroids, retinoid gel, Vitamin D3 analogues and calcineurin inhibitors are most commonly used in which skin condition?

A

Psoriasis

117
Q

What is vitiligo?

A

A progressive condition where melanocytes lose their ability to produce melanin which results in depigmentation of the skin

118
Q

What can 3 things can aid in re-pigmenting the affected skin with a diagnosis of vitilgo?

A

UVB light, photochemotherapy and topical steroids in early stages

119
Q

Anxiety must do what in order to be considered a psychiatric syndrome?

A

Interfere with everyday life

120
Q

First line treatment for anxiety are what two classes of drugs?

A

SSRIs(Paxil and Zoloft) and SNRIs(Cymbalta and Effexor), Buspar can be given for PRN use, Benzos would be given last because of the side effects and withdrawal effects

121
Q

What are some of the main symptoms of major depressive disorder that must be present most of the day, every day, for at least two weeks for a diagnosis?

A

sad or depressed mood, loss of interest in usual activities, fatigue, weight gain, unable to sleep, difficulty concentrating, worthlessness, guilt, suicidal ideation

122
Q

What is the drug of choice for major depressive disorder?

A

SSRIs, should continue therapy for 6-12 months after remission

123
Q

STI and HIV testing is recommended as routine care for a sexual assault survivor. True or False?

A

FALSE. It is not recommended as routine care.

124
Q

What is the name of the diagnostic criteria for anorexia, bulimia, and substance use disorder?

A

DSM-5 criteria, used in SUD to determine the severity of the disorder (2-3 is mild, 4-5 is moderate, 6 or > is severe)

125
Q

What are the four screening tools used to detect substance use disorder (SUD)?

A

National Institute on Drug Abuse (NIDA) Quick Screen, NIDA modified ASSIST, CAGE-C, and AUDIT

126
Q

Medication assisted treatment for alcohol use includes what medications?

A

Naltrexone (ReVia), Disulfiram (Antabuse), and Acamprosate (Campral)

127
Q

Medication assisted treatment for opiod use includes what medications?

A

Subutex, Methadone, ReVia, and Naloxone

128
Q

The most common type of anxiety disorder is?

A

Specific phobia

129
Q

Which skin cancer presents as translucent, rolled boarders, central ulcerations, and telangiectasis?

A

Basal Cell Carcinoma

130
Q

What is the first line treatment for community acquired pneumonia either viral or bacterial?

A

Azithromycin

131
Q

What drugs are contraindicated in women with G6PD deficiency?

A

Sulfa drugs, sulfa derivatives, Macrobid, NSAIDs, toludine blue and methylene blue

132
Q

What causes hemolysis in a woman with G6PD?

A

When the woman has an infection or when she receives oxidative drugs (Sulfa drugs, sulfa derivatives, Macrobid, NSAIDs, toludine blue and methylene blue)

133
Q

What is the most sensitive test for carpel tunnel?

A

Carpel compression test

134
Q

Comparison of mean peak BMD of normal, young, same-sex population and is most commonly used when making decisions about midlife and older women is which (t score or z score)?

A

T score

135
Q

Comparison with a reference population of the same age, gender, ethnicity and is used primarily for children, teens and young adults is which (t score or z score)?

A

Z score