continued family med notes qs

Question 1

criteria for non suicidal self injury

Answer 1

NSSI >5 days in the past year
-expects NSSI will solve problem/provide relieve
-experiences at least one of: negative thoughts immediately before NSSI, preoccupation with NSSI, frequent thougts of NSSI
-NSSI is related to clinically significant distress across different domains of function
-not in the context of psychosis, delerium, substance use

Question 2

what is the recommended nap duration during shifts?

Answer 2

30 minutes or less

Question 3

what two criteria suggest need for antibiotics during an ECOPD?

Answer 3

-increased purulence of sputum
-moderative - severe symptoms

Question 4

having 1 moderate exacerbation of COPD in the last year puts you into what risk group?

Answer 4

mod/severe with low risk AECOPD

Question 5

having 1+ SEVERE exacerbation, or 2+ MODERATE exacerbations of COPD in the last year puts you into what risk group?

Answer 5

high risk of AECOPD

Question 6

what are the risk factors for pseudomonas infection in COPD patients?

Answer 6

FEV <35%, chronic steroids, constant purulent sputum

Question 7

which patients with COPD should undergo pulmonary rehab?

Answer 7

those who remain dyspneic despite LAMA/LABA

Question 8

first line antibiotics for a simple AECOPD

Answer 8

Amoxicillin
Doxycyline
Tretracycline

Question 9

which COPD patients should be referred to resp? Name at least FIVE

Answer 9

1. Unclear diagnosis
2. Symptoms severe/disproportionate to spirometry
3. Accelerated decrease of lung function
4. Onset <40 yeras old
5. Failure to respond to therapy
6. Complex comorbidities
7. Assessment for pulmonary rehab
8. Home ox
9. Surgical therapy assessments

Question 10

Name 4 complications of COPD

Answer 10

skeletal muscle deconditioning, right heart failure, polycythemia, MDD

Question 11

what is upper airway cough sydnrome?

Answer 11

coughing due to PND, cough receptor irritation, GERD, etc.

Question 12

what are the two patterns of allergic rhinitis?

Answer 12

seasonal (reactions to pollen)
Perennial (dust, dust mites, animal dander, fungal spores)

Question 13

name 5 types of rhinitis

Answer 13

-allergic rhinitis
-non allergic
-vasomotor
-food induced
-alcohol induced
-work related
-atrophic

Question 14

Clinical features of allergic rhinitis

Answer 14

Allergic cause PLUS at least one of:: nasal congestion, rhinorrhea, itchy nose, sneezing

Question 15

Investigations for allergic rhinitis

Answer 15

Do aeroallergen skin prick testing or IgE testing to confirm diagnosis
Do NOT routinely order food allergy testing

Question 16

What advice to you provide to someone with seasonal allergic rhinitis?

Answer 16

Stay indoors during peak pollen times
Keep windows closed and use air purifiers

Question 17

what can you prescribe for SEVERE rhinitis or +++ edema not improved with nasal meds?

Answer 17

oral corticosteroids 5-7 days

Question 18

Name 3 different criteria for clinical anaphylaxis diagnosis?

Answer 18

1. Acute onset (min-hour) involving skin & mucosal tissues & either resp, hypotension or end organ dysfunction
2. Two system involvment including skin/mucosal, resp, hypotension, GI sx
3. Hypotension secondary to allergic trigger

Question 19

if someone is hypotensive due to anaphylaxis and is on a beta blcoker, what should you give?

Answer 19

glucagon

Question 20

what medication is indicated for all HF patients regardless of EF?

Answer 20

SGLT2i

Question 21

what medication should be considered in all patients with advanced (NYHA III or IV) heart failure with reEF?

Answer 21

hydralazine

Question 22

first line treatment of alopecia areata

Answer 22

intralesional steroids

Question 23

what investigations would you consider ordering in someone with statin induced myopathy?

Answer 23

-ALT, AST, bilirubin, alk phos
-if concern for rhabdo: creatinine, urine myoglobin

Question 24

what should you monitor in someone with a statin induced myopathy?

Answer 24

monitor their CK until normal

Question 25

how may hypothyroid change someones blood lipids?

Answer 25

-increased LDL
-increased triglycerides

Question 26

what is the guideline for pediatric lipid screening?

Answer 26

screen children 2-10 once then based on risk from three

Question 27

how is pediatric hyperlipidemia diagnosed?

Answer 27

avereage of two fasting lipid profiles 2-12 weeks apart

Question 28

a child has initial blood screening showing abnormal lipid profile. What else should you order?

Answer 28

-repeat fasting lipids
-A1C
-FPG
-TSH
-ck
-LFTs
-urinalysis

Question 29

what is the LDL target in someone who has LDL > 5 or FHL?

Answer 29

decrease by 50% or <2.5

Question 29

what is the LDL target for someone with DM/CKD?

Answer 29

<2

Question 30

what is the LDL target in someone with ASCVD?

Answer 30

<1.8

Question 31

what lipid abnormalitiy is particularly associated with pancreatitis?

Answer 31

hypertriglyceridemia

Question 32

does severe pancreatitis require antibiotics?

Answer 32

no

Question 33

what patients with stable chest pain get a CCTA?

Answer 33

low-mod risk patients

Question 34

which patients with stable chest pain get angiography?

Answer 34

those that are HIGH risk for CAD and diagnosis is unlcear

Question 35

which patients with stable chest pain get exercise stress test?

Answer 35

No risk factors, and pretest likelihood > 10%

Question 36

which patients get persantine echo/sestamibi for stable chest pain?

Answer 36

-if unable to exercise and no LBBB