Primary Care Flashcards
Vitamin D requirements by age
(National Osteoporosis Foundation)
50yrs and younger- 400-800IU/day
51yrs and older- 800-1000IU/day
Calcium requirements by age
National Osteoporosis Foundation
50yrs and younger- 1000mg
51yrs and older- 1200mg
Folate requirements
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
Iron requirements by age
14-18yrs- 15mg/dL a day
19-50yrs- 18mg/dL a day
over 51yrs- 8mg/dL a day
Sodium intake for African Americans and HTN/DM/kidney disease
no more than 1500mg per day
Physical activity recommendations weekly
150-300min of moderate or 75-150 vigorous per week
Screening for alcohol use
AUDIT-C and Single Alcohol Screening Question
LAIV- live flu vaccine, who can you give it to?
Only give in healthy, non-pregnant, between ages of 2-49
HPV vaccine dosage schedule if younger than 15?
administer 2 doses with second dose 6-12mo after first dose
New 2017 HTN Guidelines
Normal: less than 120/80
Elevated: 120-129/80 or less
Stage 1: 130-139/80-90
Stage 2: greater than 140/90
Cholesterol levels
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
What is the first line treatment for elevated and stage 1 HTN? What is the second line treatment for stage 1 HTN?
Lifestyle modifications
Second line treatment for stage 1 is medication
What is the first line treatment for stage 2 HTN?
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)
HPV vaccination dosage schedule if >15 years old?
Give 3 doses with second dose 2 months after first and third dose 6 months after first
What is the recommended age range to begin HPV vaccinations?
11-12 years old with 9 years old being the youngest
What are the recommendations for colorectal cancer screening (ACS)?
Adults >45 years should undergo regular screening with either a high-sensitivity stool test or structural exam (colonoscopy, flexible sigmoidoscopy or CT colonography)
When and for whom do USPTF and ACS recommended lung cancer screening?
Individuals 55-74 years old who have risk factors such as 30+ PPD smoking history and still smoking or quit within last 15 years
When is diabetes screening recommended and how frequently?
Every 3 years starting at age 45
USPSTF recommends periodic assessment of total cholesterol, LDL and HDL in what age range?
40-75 years old
At what age should a woman begin to have bone mineral density testing?
65
When is hepatitis C screening recommended?
Once for all women born between 1945-1965 unless other risk factors are present
Hepatitis B immunization schedule
Three dose series: second and third doses at 1 and 6 months after the first.
What are the recommendations regarding PCV13 and PPSV23 for immunocompetent individuals and which should be given first?
One time dose of PCV13 and PPSV23 for all immunocompetent individuals >65 years old, given one year apart and starting with PCV13
Recommendations for varicella vaccination?
Recommended for all non-pregnant adolescents/adults without immunity. Given in two doses 4-8 weeks apart
Recommendations for zoster (shingles) vaccination (RZV)?
two dose series 2-6 months apart for adults >50 years old
Recommendations for meningococcal vaccination?
Recommended initial vaccination at age 11-12 with booster at age 16.
Booster not needed if initial vaccine given at age 16
Bone mineral density T-scores
Normal: greater than -1
Osteopenia: -1 to -2.5
Osteoporosis: at or below -2.5
When does Troponin I and T become elevated after an event and how long is it elevated for?
3-4 hours after event and is elevated for 7-14 days after event
What is are the first line treatments (2) for allergic rhinitis?
Antihistamines and nasal corticosteroids
What are the symptoms of bacterial conjunctivitis and how do you treat it?
Mucopurlulent discharge
Broad spectrum topical antibiotic- erthryomycin
What are the symptoms of viral conjunctivitis and how do you treat it?
Watery discharge
Cold compresses and lubricants (liquid tears) for comfort
What is the first line treatment for acute otitis media if it does not first resolve spontaneously on its own?
Amoxicillin followed by Augmentin if there is an inadequate response
When should you give Augmentin (or Doxycycline if PCN allergic) for sinusitis?
If symptoms last >10 days without any improvement, symptoms worsen after 5-6 days after initially improving or high fever >102
What is first line treatment for strep throat (GABHS)?
Penicillin V or Amoxicillin
What is the classic triad of symptoms for mono?
fever, sore throat and swollen lymph nodes
If a woman has a latent TB infection, what are they treated with and for how long?
Isoniazid for 9 months supplemented with Vitamin B 6 (pyridoxine)
If a woman has active TB, what are they treated with and for how long?
Isoniazid, rifampin, pyrazinamide for 2 months followed by isoniazid and rifampin for 4 additional months
What is the Rome 3 criteria for IBS?
recurrent abdominal pain for at least 3 days per month in the previous 3 months
For pain predominant IBS, what two classes of drugs could you treat it with?
Antispasmodic/anticholinergic (Bentyl) Tricyclic antidepressants (amitriptylin/Elavil)
What is a positive Rovsings sign?
RLQ elicited when LLQ is deeply palpated and pressure is released (rebound)
What QI disorder causes early morning awakening, occurs in clusters and is associated with h pylori?
Peptic ulcer disease (PUD)
What is the triple therapy that you treat h. pylori with?
PPI, amoxicillin and clarithromycin
What does a positive HBV surface antigen (HbsAg) indicate?
The person is infectious and has acute and chronic infection
What do IgG antibodies indicate?
Previous infection or immunity
What do IgM antibodies indicate?
Current infection
What does a positive HBV surface antibody (anti-HBs) indicate?
Immunity due to prior infection or vaccination
What is the treatment for a non-pregnant woman with a UTI/cystitis?
Trimethoprim-sulfamethoxazole 3-day regimen or nitrofurantoin for 5 days
What is considered ‘recurrent UTIs’?
at least 2 culture proven and symptomatic infections in 6 months or 3 in one year.
What is the gold standard to diagnose urolithiasis?
CT scan
What is a normal hemoglobin level?
greater than 12 g/dL
What are the values for Microcytic anemia and what does it indicate?
MCV <80, iron-deficiency, thalassemia trait
What are the values for Macrocytic anemia and what does it indicate?
MCV >80, vitamin B12 deficiency, folate deficiency, liver disease, hypothyroidism
What are the values for Normocytic anemia and what does it indicate?
MCV 80-100, anemia of chronic disease, sickle cell, renal failure, hemolysis
What level Hct constitutes ‘severe anemia’?
Hct less than 25%
True or False….Antiretroviral drugs given in pregnancy to an HIV positive mother reduces vertical transmission rate to fetus?
TRUE
What CD4 cell count is present with AIDS-PCP?
below 200 cells/mm3, normal is 800-1050 cells/mm3
What is the purpose of quantitative plasma HIV RNA testing in a person with an established HIV infection?
predicts progression of disease by indicating viral load and used to make decisions about initiating antiviral medications and monitoring response to medication
What is the purpose of CD4 cell count testing in a person with established HIV infection?
indicative of immune status and predictor of disease progression
What score is needed on the RA algorithm to classify as RA?
total of 6 out of 10 in four categories
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?
RA
What class of drugs is used to treat RA?
DMARDs, can use NSAIDs and corticosteroids for short term management until DMARDs take effect
What are the 5 components of metabolic syndrome?
abdominal obesity, insulin resistance, elevated triglycerides and low HDL, HTN, and pro-inflammatory state
The classic symptoms of diabetes are?
3 Ps: polyuria, polydipsia, and polyphagia
What are the diagnosis criteria for diabetes? There are four and you only need one of them to make a diagnosis.
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
Free T4 and TSH is usually elevated or decreased with Hyperthyroidism?
T4 elevated and TSH decreased
Free T4 and TSH is usually elevated or decreased with Hypothyroidism?
T4 decreased and TSH elevated
What are two common pharmacological treatments for hyperthyroidism?
PTU and methimazole
What disease is commonly associated with hyperthyroidism?
Graves disease
What disease is commonly associated with hypothyroidism?
Hashimoto’s disease
What is a common pharmacological treatment for hypothyroidism?
Levothyroxine, should measure TSH every 4-6 weeks and adjust treatment
What level of TSH indicates treatment needed for hypothyroidism?
TSH greater than 10uIU/mL or levels of 5-10 with symptoms
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?
OA
RA and SLE can be ruled out as differentials for OA with what symptoms and tests?
normal RF/ANAs and inflammation present with symmetrical joint distribution, these are findings in OA not RA and SLE
In a post menopausal woman with osteopenia, what test is used to make decisions concerning preventative medication?
FRAX algorithm
Vertebral fraction is consistent with a diagnosis of osteoporosis along with BMD results. True or False?
FALSE. In an older woman, a vertebral fracture is an independent finding to warrant a diagnosis of osteoporosis regardless of BMD results.
What are some FDA approved drugs to treat fibromyalgia?
Lyrica, SNRIs-Cymbalta
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?
erythrocyte sedimentation rate
What 3 classes of medications can be given to someone as prophylactic therapy for migraines?
Beta-blockers (propranolol), CCB (verapamil), or anti epileptic meds (valproic acid, depakote, topamax)
What is the most common form of headache?
Tension
Is a migraine headache usually unilateral or bilateral?
Unilateral
Nausea, vomiting, photophobia, phono-phobia and fatigue are all associated symptoms of which type of headache?
Migraine
Which type of headache is often nocturnal (waking patient from sleep)?
Cluster headaches
What 2 classes of medications can be given for chronic tension headaches?
TCAs (amitriptyline, nortriptyline) or SSRIs
Obstruction of the pilosebaceous follicle is the primary cause of what?
Acne
What are some contributing/aggravating factors for acne?
Hormonal cycles, topical/oral corticosteriods, irritant oils or cosmetics
What are two medications that can be prescribed for mild acne?
Benzoyl peroxide and retinoic acid derivatives
What do you need to educate women to avoid when taking retnioic acid derivatives?
UV light, sun and extreme weather
What two antibiotics can you prescribe for moderate to severe acne?
Doxycycline and minocycline
Which drug for severe cystic acne is contraindicated with pregnancy and lactation?
Accutane
Mild irritants may cause what symptoms (3) in irritant contact dermatitis?
Erythema, dryness and fissuring
What are ‘classic lesions’ of allergic contact dermatitis?
Versicles and blisters on erythematous base
What (4) non pharmacologic measures can you recommend for contact dermatitis?
Compresses, epsom salt soaks, lubricating ointments and petrolatum
Extremely pruritic, erythematous, dry, scaly, excoriated, lichenified patches of skin are characters of which skin condition?
Eczema
Education to moisturize frequently with a thick heavy moisturizer is for which skin condition?
Eczema
If eczema is severe and does not respond to steroids or topical immunosuppressants, what can be considered?
An oral immunosuppressant
Which type of skin cancer is second most common in whites and most common in blacks?
squamous cell carcinoma
Chronic sun exposure and genetics are possible causes for which type of skin cancer?
Basal cell carcinoma
Sun exposure or chronic irritation are possible causes for which type of skin cancer?
Squamous cell carcinoma
What are symptoms of both BCC and SCC?
Painless, slow growing lesions that will not heal on sun-exposed area or skin damaged by burns or chronic inflammation?
What is an early symptom of malignant melanoma?
Pruitis
Which type of skin cancer tends to follow the ABCDEs?
Malignant melanoma
What does ABCDE stand for?
Asymmetry, border irregularity, color variations, diameter >6mm and elevation
How often is a total cutaneous examination (TCE) recommended for populations with risk factors?
Annually
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?
Mohs microsurgery
BCC and SCC
What is tinea/dermatophytosis?
A superficial fungal infection caused by dermatophytes and yeasts
What three areas is dermatophytosis restricted to and why?
Hair, superficial skin and nails
Because dermatophytes require keratin for growth
What is tinea capitis and whom is it most common in?
Fungal infection on the scalp
Children
How are fungal infections transmitted?
Via contact with infected persons, fomites (shoes, towels, shower stalls), animals or soil
What is a the ‘classic presentation’ of tinea?
Central clearing surrounded by an advancing, red, scaly, elevated border
What would you see on KOH microscopy if a person had tinea?
Hyphae
What rash looks like a Christmas tree on the trunk and will go away on its own?
Pityriasis rosea
What two classes of anti-fungals would you treat tinea corporis, cruis and pedis with?
Azoles (lotrimin/monistat) or allylamines (Lamisil/Naftin)
A chronic immune mediated disorder with overgrowth of keratinocytes and accompanies inflammation is what skin condition?
Psoriasis
What 4 prominent features does psoriasis have?
Sharply demarcated with clear borders
Erythematous plaque base
Overlapping silvery scales
Removal of scales cause small droplets of blood
What is the non-pharmacologic treatment for psoriasis?
Sun exposure or UV B radiation
Steroids, retinoid gel, Vitamin D3 analogues and calcineurin inhibitors are most commonly used in which skin condition?
Psoriasis
What is vitiligo?
A progressive condition where melanocytes lose their ability to produce melanin which results in depigmentation of the skin
What can 3 things can aid in re-pigmenting the affected skin with a diagnosis of vitilgo?
UVB light, photochemotherapy and topical steroids in early stages
Anxiety must do what in order to be considered a psychiatric syndrome?
Interfere with everyday life
First line treatment for anxiety are what two classes of drugs?
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
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?
sad or depressed mood, loss of interest in usual activities, fatigue, weight gain, unable to sleep, difficulty concentrating, worthlessness, guilt, suicidal ideation
What is the drug of choice for major depressive disorder?
SSRIs, should continue therapy for 6-12 months after remission
STI and HIV testing is recommended as routine care for a sexual assault survivor. True or False?
FALSE. It is not recommended as routine care.
What is the name of the diagnostic criteria for anorexia, bulimia, and substance use disorder?
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)
What are the four screening tools used to detect substance use disorder (SUD)?
National Institute on Drug Abuse (NIDA) Quick Screen, NIDA modified ASSIST, CAGE-C, and AUDIT
Medication assisted treatment for alcohol use includes what medications?
Naltrexone (ReVia), Disulfiram (Antabuse), and Acamprosate (Campral)
Medication assisted treatment for opiod use includes what medications?
Subutex, Methadone, ReVia, and Naloxone
The most common type of anxiety disorder is?
Specific phobia
Which skin cancer presents as translucent, rolled boarders, central ulcerations, and telangiectasis?
Basal Cell Carcinoma
What is the first line treatment for community acquired pneumonia either viral or bacterial?
Azithromycin
What drugs are contraindicated in women with G6PD deficiency?
Sulfa drugs, sulfa derivatives, Macrobid, NSAIDs, toludine blue and methylene blue
What causes hemolysis in a woman with G6PD?
When the woman has an infection or when she receives oxidative drugs (Sulfa drugs, sulfa derivatives, Macrobid, NSAIDs, toludine blue and methylene blue)
What is the most sensitive test for carpel tunnel?
Carpel compression test
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)?
T score
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)?
Z score
