Flashcards in AAFP Review Questions Deck (466)
Loading flashcards...
241
Mammograms
Starting at 50: every 2 years
D/c after 75
242
Pap smears
Begin at 21 and do every 3 years
For women over 30, can do every 5 years by co-testing with HPV cytology
Stop at 65 if had 3 consecutive negative Paps or two consecutive negative HPV results within the last 10 years
If cervix has been removed, testing is no longer necessary
243
Osteoporosis diagnosis
DXA T-score at or below -2.5
Osteopenia: -1 - -2.5
244
DXA scan
65 and over, and under 65 with high risk
245
Calcium and vitamin D for primary prevention of fractures in osteoporosis
Level D
246
Ottowa knee rules
Perform X-ray if any one:
1. >55
2. isolated patella tenderness
3. tenderness of the head of the fibula
4. inability to flex the knee to 90 degrees
5. inability to bear weight for 4 steps immediately and in the exam room (regardless of limping)
247
Management of most acute sprains
PRICE
-protection
-rest
-ice
-compression
-elevation
NSAIDs or acetaminophen for pain control
Early mobilization of injured ligaments promotes healing and recovery
-begin ROM exercises 48-72 hours after injury
248
Excision borders of melanoma in situ
5mm
249
Superficial spreading melanoma location
Men: torso
Women: legs
250
Acral lentiginous melanoma
More common in blacks and Asian
Under nails, soles of feet, palms
251
ABCDEs of melanoma
Asymmetry
Borders (irregular)
Color (variegated)
Diameter (>6 mm)
Elevation/Evolving
252
Excision margins for lesion concerning for melanoma
2-3mm
If biopsy confirms malignancy, want 5mm margins
253
What factor is most important in the prognosis of melanoma?
Breslow factor (depth): <1 mm thick have a low rate of metastasis
254
First-time microscopic hematuria
Follow up with repeat UA and microscopy in 6 weeks before any other management is done
255
Graves disease finding on radionucleotide scan
Diffuse increased uptake
256
Graves disease treatment
Radioactive iodine (in non-pregnant patients- don't use in children or breastfeeding mothers)
In adolescents:
-antithyroid drugs: PTU, methimazole, carbimazole (inhibit organification of iodine; PTU also inhibits peripheral conversion)
-may go into spontaneous remission after 6-18 months of therapy
257
PTU vs. methimazole
Methimazole is first-line unless pregnant (PTU preferred for 1st trimester)
PTU: black box warning for HEPATOTOXICITY
Watch for agranulocytosis
258
Evaluation of thyroid nodule
TSH and ultrasound
Nodules >1 cm on US require biopsy (FNA)
259
Stages of labor
1. onset of labor until cervix is completely dilated
-latent phase: contractions become stronger, longer lasting, and more coordinated
-active phase: usually starts at 3-4 cm of dilation; rate of cervical dilation at its maximum; contractions usually strong and regular [INDICATION FOR ADMISSION TO BIRTHING UNIT]
2. complete cervical dilation (10 cm) through delivery of fetus
-normal < 2 hrs in nulliparous woman and < 1 hr in parious woman
-epidural can prolong by up to 1 hr
3. delivery of baby until delivery of placenta and membranes
-prolonged if > 30 min
260
Determinants of the progress of labor
1. Power
-strength of uterine contractions
-strength of maternal pushing efforts
2. Passenger
-fetus size, lie, presentation, position within birth canal
3. Pelvis
-size, shape
261
Confirm rupture of membranes
Exam:
-fluid leaking from cervical os (either spontaneously or w/ Valsalva)
-presence of amniotic fluid pooling in the posterior vaginal fornix
Amniotic fluid:
-Nitrazine test: pH > 6.5 (normal vaginal secretions < 5.5)
-ferning (under microscope)
262
Fetal cardinal movements
1. Flexion
2. Internal rotation
3. Extension
4. External rotation
263
Treatment of maternal GBS
penicillin (or ampicillin)
264
Hypovolemic hyponatremia etiologies and treatment
Cerebral salt wasting, skin loss, diuretic use, GI losses, mineralocorticoid deficiency, third-spacing
See signs of volume depletion
Tx: normal saline and treat underlying condition
Severe symptomatic: <125
-confusion, seizures, coma
-urgent treatment with 3% (hypertonic saline)
-but go slow d/t risk of osmotic demyelination ("from low to high your pons will die")
265
Hypervolenic hyponatremia etiologies and treatment
Heart failure, cirrhosis, nephrosis
Exhibit signs of volume overload
Tx: diuretics and restriction of sodium and water intake
266
Euvolemic hyponatremia etiologies and treatment
SIADH (d/t infections, malignancy, drugs, CNS disorders), primary polydipsia, water intoxication, hypothyroidism, low solute intake ("tea and toast syndrome")
Tx: fluid restriction and treat underlying cause
267
Pseudohyponatremia
Low plasma [Na+] in the setting of hyperglycemia, hypertriglyceridemia, hyperproteinemia, laboratory errors, or mannitol use
Usually have normal volume status with normal osmolality
268
Management plan for hyperkalemia
1. stabilize myocardium w/ IV calcium gluconate
2. shift K+ intracellularly with insulin and glucose
3. lower total body K+ with Kayexalate, loop diuretics, or dialysis
4. Address underlying cause
269
Centor criteria
For suspicion of GAS
Points given for:
-absence of cough
-enlarged/tender anterior cervical adenopathy
-fever of 100.4 or higher
-tonsillar swelling/exudates
0-1: no further testing or abx warranted
2-3: perform rapid strep or throat culture and treat w/ abx if positive
4+: consider empiric abx treatment
270
