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%