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Amb Care > Step Up 1 > Flashcards

Step Up 1 Flashcards

1
Q

Gait unsteadiness in elderly pt- what to investigate

A

Don’t always just chalk it up to old age, consider cervical stenosis (spinal cord compression in the cervical spine)

  • earliest symptom of cervical myelopathy is gait disturbance
  • can be treated w/ surgery to decompress the spinal cord
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2
Q

Standard of care medical management of stable angina

A

Stable angina needs 3 things:

  • aspirin
  • beta blocker: atenolol, metoprolol
  • nitrates PRN for CP
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3
Q

Docusate sodium

A

Docusate sodium = Colace

-surfactant laxative which decreases stool’s surface tension

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4
Q

Screening vs. diagnostic test

A

Screen is in an asymptomatic person, primary prevention (before any signs of idsease appear)

Diagnostic test- when test is being used in attempt to find cause of a symptom

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5
Q

Use of CCBs for stable angina

A

CCBs cause coronary vasodilation and reduces afterload and contractility, but NOT indicated as first line therapy for stable angina
-try CCBs if symptoms continue despite nitrates and beta-blockers

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6
Q

Differentiate the two major classes/types of bariatric surgery

A
  1. restriction of intake
    - make the stomach smaller
    ex: LapBand
  2. malabsorption
    - by decreasing small bowel length
    ex: Roux-en-Y gastric bypass
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7
Q

When do we give adults TDaP?

A

TDaP- give adults over 19 a new TDaP (or if never have had before)
-then get TD booster every 10 years

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8
Q

When is revascularization considered in stable angina

A

When symptoms aren’t controlled by medication (aspirin, beta blocker, nitrates w/ second line CCB)

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9
Q

What therapy to add to stable angina if CHF is also present

A

ACEi and/or diuretics in addition to 3 for stable angina (aspirin, beta blocker, nitrates PRN)

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10
Q

Ideal age for HPV vaccine

A

Routinely given at age 11-12, recommended 9-26 yoa

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11
Q

USPSTF DM screening guidelines

A

DM screening: Screen overweight adults (BMI > 25) q3y

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12
Q

Which is kentucky vs. tennessee?

A

Ken(S1)-tuck(S2)-Y(S3) = S3 = ventricular gallop
-S3 follows S2

TEN(S4)-nes(S1)-see(S2)
-S4 preceeds S1

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13
Q

USPSTF cervical cancer screening guidelines

(a) starts at what age
(b) how often repeat
(c) when start doing HPV testing
(d) discontinue at what age

A

USPSTF cervical cancer screening guidelines

(a) First pap smear at 21 regardless of sexual history
(b) If normal repeat every 3 years
(c) Start adding HPV test every 5 yrs at age 30
(d) Can stop if adequate negative prior screening at age 65

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14
Q

USPSTF colorectal cancer screening guidelines

(a) what age
(b) how often repeat
(c) alternative equivalent to colonscopy- advantage and disadvantage

A

Colorectal cancer screen

(a) ages 50-75 for average-risk pts
(b) Colonoscopy q10 years (if normal)
- flex sig every 5 yrs w/ fecal occult blood q3y
- fecal occult blood test annually: if find something on fecal occult, need to do colonoscopy to treat
(c) Flex sig q5y + barium enema = colonoscopy
- colonoscopy more expensive

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15
Q

Criteria for hypertension screening

A

HTN screening: USPSTF recommends screening for all adults > 18 yoa

  • every 2 yrs for adults w/ normal BP
  • every 1 yr for adult w/ prehypertension
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16
Q

When do we give adults the Hep B vaccine?

A

Hep B vaccine

  • ppl from countries where Hep B is endemic: Asia, Africa, Peru
  • ppl w/ chronic liver disease
  • MSM, IVDU
  • healthcare workers
  • given as primary series to infants
17
Q

Where are S3 and S4 heard best?

A

S3- heart best at apex w/ bell of stethoscope

S4- heard best at left sternal border w/ bell

18
Q

Psyllium seed

A

Psyllium seed = Metamucil = Bulk laxative

-absorbs water into intestinal lumen to increase fecal mass

19
Q

Which vaccinations can be given as postexposure prophylaxis?

A
  • Varicella

- Rabies

20
Q

Who gets pneumococcal vaccine?

A

Pneumococcal vaccines: PPSV23 and conjugate PCV13

  • adults over 65: PPSV23
  • adults 19-64 w/ immunocompromised state: PCV13 then PPSV23 8 weeks later
  • adults w/ chronic medical problems (ex: COPD, DM) get PPSV23 before 65
21
Q

Who gets the meningococcus vaccine?

A
  • asplenic
  • travelers to endemic area
  • military personnel
  • college students
  • close contacts w/ sporadic disease
22
Q

Problem of supply and demand for stable vs. unstable angina

A

Stable angina = problem of demand (too high)

Unstable angina = problem of supply (too low)

23
Q

When do we give adults the Hep A vaccine?

A

Hep A vaccine

  • ppl born btwn 1945-1965
  • ppl w/ chronic liver disease
  • MSM, IVDU
  • travelers to developing countries
24
Q

Exact criteria for Metabolic syndrome

A

Metabolic syndrome: at least 3 of these 5:

  1. Central obesity
    - waist circumference > 40 in M, > 35 F
  2. BP > 130/85
  3. Fasting TG > 150
  4. Fasting HDL under 40 M, under 50 F
  5. Fasting blood sugar > 100 mg/dl
25
Q

Measurement to differentiate dyspnea caused by CHF and COPD

A

BNP: released from the ventricles in response to ventricular volume expansion and pressure overload

High BNP (over 150) correlate strongly w/ decompensated CHF

26
Q

USPSTF recommendations for hyperlipidemia screening

(a) What is looked for on screening
(b) How often do you repeat

A

Hyperlipidemia screening

  • start at age 35+ M, 45+ F
  • start at 20 for both genders at increased risk

(a) Screening test = nonfasting total cholesterol (target: under 200) and HDL (target: over 35)
(b) If normal: repeat screen in 5 yrs
- if abnormal: get complete lipid profile (TG level and LDL)

27
Q

Which adult vaccinations are contraindicated during pregnancy?

A

Live-attenuated: so varicella, zoster (not till 60/65 anyway), MMR

28
Q

What vaccines should a functionally or anatomically asplenic pt get?

A

Asplenic individuals are at increased risk of infection w/ encapsulated organisms => get HIB vaccine, meningococcal and pneumococcal vaccines

29
Q

USPSTF lung cancer screening guidelines

A

USPSTF: annual non-lose CT scan in smokers with more than 30+ pack year history who haven’t quit in the last 15 years

30
Q

USPSTF breast cancer screening guidelines

A

USPSTF: Mammography q2y from age 50-74

-other institutions recommend every year starting ate age 40

31
Q

4 medications for glaucoma tx

A

Glaucoma- want to decrease IOP, use these 4 alone or in combo

  • beta blocker
  • alpha agonist
  • carbonic anhydrase inhibitor
  • prostaglandin analogue
32
Q

Explain pathologic S3 vs. S4

A

Pathologic S3 = rapid filling phase into a noncompliant LV

  • low frequency diastolic sound after S2 associated w/ LV failure
  • inflow from LA strikes blood already in the LV => reverberation of blood btwn LV walls

Pathologic S4 = sound of atrial systole as blood is ejected into a noncompliant (stiff) LV

33
Q

Cutoff EF for preserved systolic fxn

A

40%

EF over 40% = preserved systolic function
EF under 40% = systolic dysfunction

34
Q

USPSTF prostate cancer screening guidelines

A

No screening suggested

-controversial, but USPSTF now advises against PSA screening

Amb Care (13 decks)

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