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FAMILY MEDICINE > Dr. Morgan > Flashcards

Dr. Morgan Flashcards

1
Q

Define Counselling

A

Counselling is a process aimed at influencing individuals’ knowledge about their health and healthcare with a purpose to not only inform but also to change behaviour

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2
Q

Principles of counselling (hint: 7)

A

Principle of acceptance
Principle of communication
Principle of empathy
Principle of non-judgemental attitude
Principle of confidentiality
Principle of individuality
Principles of non-emotional involvement

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3
Q

The most common sickle cell syndromes (i.e., genotypes) are (hint: 3)

A

Sickle Cell Anaemia - 65%
Hemoglobin SC disease - 25%
Hemoglobin S Beta Thalassemia,

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4
Q

Some people with sickle cell trait can show the hematological abnormalities of sickle cell syndrome, T/F

A

FALSE

Sickle trait not associated with any hematological abnormalities

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5
Q

Sickle cell disease is the most common inherited blood disorder, T/F

A

TRUE

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6
Q

Male to female ratio of SCD IS 1:2, T/F

A

FALSE

Male / Female 1:1

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7
Q

Composition of Adult hemoglobin A2 is ________

A

2-alpha chains & 2-delta chains

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8
Q

There are 6 different globin chains, name them

A

( i ) Alpha with 141 a.a ( ii ) Beta ( iii ) Gamma ( iv) Delta
(v) Epsilon ( vi) Zeta All with 146 a.a

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9
Q

In HbS there is substitution of Thymine for Adenine in the 6th codon of beta chain, T/F

A

TRUE

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10
Q

The loss of _______ is central to the pathophysiology of sickle cell disease

A

red blood cell elasticity

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11
Q

Sickle cells only function/last for __ to __ days

A

10 - 20 days

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12
Q

Clinical features of Sickle anemia varies among patients, T/F

A

TRUE

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13
Q

The earliest clinical feature of sickle cell anemia is ______

A

Dactylitis- painful swellings of the hands and feet

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14
Q

The anemia in SCD is microcytic hypochromic, T/F

A

FALSE

Normocytic normochromic anemia (Hall mark on FBC)

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15
Q

The average Hb conc. in SCD is ______

A

8g/dL

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16
Q

Howell-Jolly bodies and Paperiheimer bodies on blood smear of SCD patient reflects ______

A

Functional asplenia

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17
Q

Prominent blood smear features of sickle cell disease (hint: 6)

A

Sickled cells, target cells and ovalocytes.
Polychromasia, basophilic stippling, and normoblasts are prominent

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18
Q

WBC count increases in vaso-occlusive crises state, T/F

A

TRUE

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19
Q

Platelet aggregation is increased in SCD, T/F

A

FALSE

Platelet aggregation is decreased, the likely result of in vivo platelet activation

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20
Q

Platelet count is decreased in SCD, T/F

A

FALSE

The platelet count is increased (approximately 440 × 109/L), reflecting reduced or absent splenic sequestration

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21
Q

Total platelets are decreased during vaso-occlusive crises, T/F

A

TRUE

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22
Q

The level of _______ indicates the severity of bone crises in SCD

A

Serum alkaline phosphatase

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23
Q

Gold standard for diagnosing SCD is

A

Hb Electrophoretic or chromatographic separation of haemoglobins in haemolysates prepared from peripheral blood

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24
Q

Lab tests to diagnosis of SCD (hint: 3)

A
  1. Haemoglobin solubility test
  2. Sickling test
  3. Hb Electrophoretic or chromatographic separation of haemoglobins in haemolysates
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25
Q

List the 4 types of crises in SCD

A

Vaso occlusive
Aplastic
Sequestration
Hemolytic/ hyperhemolytic

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26
Q

Concerning SCD crises, the hallmark of the disease is _______

A

Vaso occlusive crisis

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27
Q

Aplastic crisis in SCD is caused by _____

A

Parvovirus B19

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28
Q

Concerning Sequestration crisis in SCD
- Major Hb conc. crisis is Hb conc of ____
-Minor Hb conc. crisis is Hb conc of _____

A

Major Hb <6g/dl
Minor Hb >6g/dl

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29
Q

Fall in >3g/dl from baseline is which SCD crises

A

Major Hb sequestration crisis

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30
Q

A person has G6PD-def. and diagnosed to have SCA, which crisis will he likely come down with?

A

Hemolytic/ hyperhemolytic

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31
Q

List the Management principles in SCD (hint: 5)

A

History, Physicals, Lab. Investigation

Health maintenance

Management of Sickle emergencies

Infection prevention

Pain management

Chronic disease/complication management

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32
Q

Which investigation is indicated for brain study in SCA patients

A

Transcranial doppler ultrasonography

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33
Q

What nutritional supplement do SCD patient need in health maintenance

A

Folate

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34
Q

Penicillin prophylaxis should begin at ____ age for SCD patient

A

2 Months

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35
Q

In health maintenance in SCD, frequent visits should be every __to __ months

A

3 to 6 months

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36
Q

In health maintenance in SCD patient, Pneumococcal vaccination is indicated at 7yrs of life, T/F

A

FALSE

Pneumococcal vaccine at five years

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37
Q

Acute chest syndrome is treated with _____

A

Blood transfusion

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38
Q

Eye trauma is an emergency in Sickle cell trait, T/F

A

TRUE

Eye trauma is an emergency in ALL sickle conditions(including sickle trait)

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39
Q

Onset of Priapism is common in the morning, T/F

A

TRUE

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40
Q

Treatment of stroke in SCD is with chronic transfusion to maintain sickle Hb(PCV) levels at or below _____

A

30%

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41
Q

Chronic pain (in SCD material) is pin lasting for > _____ to ___ months

A

> 3 to 6 months

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42
Q

The risk factors that points to progressive renal failure are (hint: 3)

A

Anemia, Proteinuria, Hematuria

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43
Q

NSAID is contraindicated in renal failure, T/F

A

TRUE

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44
Q

Mention Anti-sickling drugs (hint: 2)

A

Solamin, Niprisan

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45
Q

Drugs to increase Fetal hemoglobin (hint: 4)

A

5-azacytidine
5-aza 2’-deoxycytidine
Cytosine arabinoside
Hydroxyurea (10-15 mg daily)

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46
Q

Highest cause of death in SCD is _____

A

Infection

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47
Q

Ways to prevent SCD are (hint: 2)

A

Screening
Counselling of carriers

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48
Q

Concerning screening of Chlamydia as one of the ways to reduce PID, annual screening is recommended for ______ & _____

A

Annual chlamydia screening is recommended for:
Sexually active women 25 and under
Sexually active women >25 at high risk

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49
Q

To reduce the incidence of PID, pregnant women are recommended to screen for Chlamydia at _____ trimester

A

1st trimester

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50
Q

Ways to prevent PID (hint: 6)

A

Abstinence
Use of condoms correctly and consistently
Avoiding multiple sexual partner
Prompt diagnosis and appropriate treatment of STI/PID
Routine screening for STI where risk exist
Contact tracing for screening/ treatment of partner

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51
Q

The 2 forms of PID are _____ & ____

A

Acute & Chronic PID

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52
Q

___% of infections occur following procedures that break cervical mucous barrier.

A

15%

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53
Q

About 55% are spontaneous infections in sexually active females of reproductive age, T/F

A

FALSE

About 85%

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54
Q

Most cases of PID are Monomicrobial, T/F

A

TRUE

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55
Q

Most common pathogens in microbial etiology of PID are _____ & ______

A

N. gonorrhoeae
C. trachomatis

N. gonorrhoeae and C. trachomatis are present in combination in approximately 25%-75% of patients

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56
Q

Between C. trachomatis and N. gonorroeae which has more severe tube involvement

A

C. trachomatis

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57
Q

Two major sequelae of PID with N. gonorrhoeae + prior C. trachomatis infection are

A

Infertility & Ectopic pregnancy

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58
Q

In < 1% of cases, acute PID can stem from other routes such as (hint: 3)

A

hematogenous routes
Lymphatic spread
transperitoneal spread

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59
Q

99% of cases of Acute PID is from ____ route

A

endometrial-endosalpingeal-peritoneal route

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60
Q

Concerning the pathophysiology of PID, the first stage is ________

A

acquisition of a vaginal or cervical infection (STDs) usually asymptomatic

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61
Q

Acute perihepatitis extending for PID is called ______

A

Fitz-Hugh−Curtis syndrome

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62
Q

Abnormal vaginal discharge is present in approximately 90% of cases, T/F

A

FALSE

75%

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63
Q

Diagnosis of PID recommended by CDC is

A

The CDC recommends instituting empiric treatment when a young woman who is at risk for STI has pelvic/lower abdominal pain, no identifiable cause for her illness other than PID, and, on pelvic examination, 1 or more of the following minimal criteria
Cervical motion tenderness
Uterine tenderness
Adnexal tenderness

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64
Q

Diagnosis of PID is usually clinical, T/F

A

TRUE

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65
Q

________ confirmatory investigation is gold standard for PID

A

Laparoscopy

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66
Q

Complications of PID (hint: 4)

A

Tubo-ovarian abscess
Infertility
Ectopic pregnancy
Chronic pelvic pain

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67
Q

The CDC recommended OUTPATIENT treatment for PID
- Regimen A
- Regimen B

A

Regimen A consists of the following
Ceftriaxone 250 mg IM in a single dose
Regimen B
Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally in a single dose

PLUS - Doxycycline 100 mg orally 2 times a day for 14 days
Metronidazole 500 mg orally 2 times a day for 14 days can be added if there is evidence or suspicion of vaginitis or if the patient underwent gyneacological instrumentation in the preceding 2-3 week (FOR BOTH

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68
Q

`The CDC recommended IN-PATIENT treatment for PID
- Regimen A
- Regimen B

A
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69
Q

Some experts recommend rescreening for C. trachomatis and N. gonorrhoeae __ to __ weeks after completion of therapy in women with documented infection with these pathogens

A

4-6weeks

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70
Q

In continuity of care, care is less costly, T/F

A

TRUE

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71
Q

Holistic care synonyms are (hint: 3)

A

Holistic health
Wholistic health,
Holism

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72
Q

Define Holistic care

A

A healing approach that considers the whole person-body, mind, spirit and emotions- and their interactions in the process of promoting health and well-being and treating disease

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73
Q

Types of treatment techniques a holistic practitioner can use

A
  1. Patient education on lifestyle changes and self-care
  2. Complementary and alternative therapies
  3. Western medications and surgical procedures
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74
Q

Chiropractor is a holistic provider, T/F

A

TRUE

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75
Q

Holistic medicine focuses mostly on lifestyle changes, T/F

A

TRUE

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76
Q

In home visits, the health worker assesses the ______ & _______ in order to provide the necessary health related care

A

Home & family situation

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77
Q

To conduct home visits effectively, physicians must acquire 3 things, name them

A
  1. fundamental and well-defined attitudes
  2. knowledge and skills
  3. an inexpensive set of portable equipment
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78
Q

Telephone and telemedicine have no role in Home visits, T/F

A

FALSE

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79
Q

The four major types of home visits are

A
  1. Illness home visits
  2. Home visits to dying patients and families
  3. Assessment home visits
  4. Hospitalization follow-up home visits
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80
Q

Hospitalization follow-up home visits can also be called ______

A

Monitoring home visits

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81
Q

Concerning the settings of home visits, match the type of home visits that applies
a. Parents with newborn
b. Polypharmacy
c. Terminal care
d. Emergency
e. Chronic illness
f. Pronouncement of death
g. Excessive use of health care service
h. Acute illness
i. Grief
j. Multiple medical problems
k. Poor compliance

A

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.

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82
Q

Assessment home visit can also be described as ________ home visit

A

Investigational home visit

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83
Q

Assessment home visit is valuable in assessing the need for nursing home placement of a frail elderly patient with uncertain social support, T/F

A

FALSE

It is INVALUABLE

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84
Q

_______ home visit is useful when significant life changes have occurred

A

Hospitalization follow-up home visit

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85
Q

Concerning conducting a home visit, list the steps in planning (hint: 6)

A
  1. Clarify the reason for the visit and carefully plan the agenda
  2. Gather the necessary equipment and patient education materials
  3. Have a map, the patient’s telephone number and directions to the patient’s home
  4. Set a formal appointment time for the visit involving the patient & home care service team
  5. Coordination of house call to allow for the presence of key family members or significant
  6. Confirm the appointment time with all involved parties before departure
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86
Q

Concerning home visit, the physician-supplied equipment is divided into 2, which are

A

Essential
Optional

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87
Q

Glucometer is an essential physician-supplied equipment, T/F

A

FALSE

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88
Q

Patient educational material is an essential physician-supplied equipment, T/F

A

FALSE

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89
Q

List the issues to assess during home visit (home visit checklist)

A

I Immobility
N Nutrition
H Housing
O Other people
M Medications
E Examinations
S Safety
S Spiritual health
S Services by home health agencies

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90
Q

Physician can make assumption about social class/material wealth based on the the patient’s environment, T/F

A

FALSE

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91
Q

Define mental health care in primary care

A

defined as “the provision of basic preventive and curative mental health care at the first point of contact of entry into the health care system.”

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92
Q

The two main diagnostic categories of common mental disorders are

A

Depressive disorders and Anxiety disorders

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93
Q

Define depression

A

Depression is a disorder of the mood that causes a persistent feeling of sadness and loss of interest (also called major depression)

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94
Q

Major depressive disorder (MDD) has been ranked as the 2nd cause of the burden of disease worldwide in 2008 by WHO, T/F

A

FALSE

3rd

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95
Q

Approximately 80% of MDD patients who achieve remission experiencing at least one recurrence in their lifetime, T/F

A

TRUE

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96
Q

List the Risk factors for Depressive disorders (hint: 9)

A

Family history and Genetics
Gender: F>M = 2:1
History of trauma/abuse
Chronic Stress
Unresolved Grief or Loss
Personality Traits
Medication and Substance Use
History of other Mental Disorders
Chronic Medical Condition

(Divide it into Modifiable & Non-modifiable)

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97
Q

Hypothyroidism can cause depression, T/F

A

TRUE

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98
Q

The DSM-5 criteria for Major depressive disorder (hint: 4)

A
  1. Five or more out of 9 symptoms (including either depressed mood, or loss of interest or pleasure) in the same 2-week period.
  2. Each of these symptoms needs to be present nearly every day
  3. Symptoms cause significant distress or impairment
    in daily function
  4. Symptoms are not secondary to substance use
    or a general medical condition
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99
Q

List the 9 symptoms associated with Depressive disorders (e.g., MDD)

A
  1. Depressed mood (subjective or observed); can be an irritable mood in children and adolescents, most of the day;
  2. Loss of interest or pleasure, most of the day;
  3. Change in weight or appetite. Weight: 5% change over 1 month;
  4. Insomnia or hypersomnia;
  5. Psychomotor retardation or agitation (observed);
  6. Loss of energy, or fatigue;
  7. Worthlessness or guilt;
  8. Impaired concentration or indecisiveness; or
  9. Recurrent thoughts of death or suicidal ideation or attempt
100
Q

In the pathophysiology of MDD, which central nervous system neurotransmitter activity plays an important factor

A

Serotonin (5-HT)

101
Q

With adequate treatment of MDD, median time at recovery is ____weeks

A

20 weeks

102
Q

Risk factors for suicide (hint: 10 - “IS PATH WARM”)

A

ideation, substance use, purposelessness, anger, trapped, hopelessness, withdrawal (social), anxiety, recklessness, mood change (dramatic)

103
Q

The lifetime risk of suicide in an untreated MDD is ___%

A

20%

104
Q

In each episode of MDD, risk of suicide becomes greater, T/F

A

TRUE

105
Q

Depression Rating scales and screening tools can be used alone to diagnose Depression, T/F

A

FALSE

should be used to augment information from the clinician’s diagnostic assessment

106
Q

Concerning Patient Health Questionnaire (PHQ-9) Depression rating scale,
score of 22 is ____
score of 6 is _____
score of 18 is _____
score of 11 is _____

A
107
Q

In the mgt of MDD, TCA may cause exacerbation of cardiac conduction abnormalities, T/F

A

TRUE

108
Q

Diagnosis of Depression is mainly clinical, T/F

A

TRUE

109
Q

Factors that favour general advice and active monitoring in Depression (hint: 6)

A
  1. four or fewer of the above symptoms with little associated disability
  2. symptoms intermittent, or less than 2 weeks’ duration
  3. recent onset with identified stressor
  4. no past or family history of depression
  5. social support available
  6. lack of suicidal thoughts.
110
Q

Factors that favour more active treatment of Depression in primary care are (hint: 5)

A
  1. five or more symptoms with associated disability
  2. persistent or long-standing symptoms
  3. personal or family history of depression
  4. low social support
  5. occasional suicidal thoughts.
111
Q

A major differential to rule out in a suspected case of MDD is _______

A

Hypothyroidism

112
Q

Mention Non-pharmacological modalities for treatment of MDD

A
  1. Lifestyle modification
  2. Psychotherapy (e.g. cognitive behavioural therapy (CBT) and interpersonal therapy)
  3. Phototherapy
  4. Refer patient to local support groups (if there are any)
113
Q

The standard treatment for MDD with seasonal pattern is _______

A

Phototherapy

114
Q

In pharmacotherapy for MDD, the classes of drugs that can be used are (hint: 6)

A
  1. Selective serotonin reuptake inhibitors (SSRIs)
  2. Serotonin-norepinephrine reuptake inhibitors (SNRIs
  3. Serotonin modulators
  4. Atypical antidepressants
  5. Tricyclic antidepressants (TCAs)
  6. Monoamine oxidase inhibitors (MAOIs)
115
Q

Concerning Pharmacotherapy for MDD, the first line for treatment is ____ class of drug

A

Selective serotonin reuptake inhibitors (SSRIs)

116
Q

Other treatment modalities of MDD excluding Non-pharmacological and pharmacotherapy) (hint: 3)

A
  1. VAGAL NERVE STIMULATION
  2. ELECTROCONVULSIVE THERAPY (ECT)
  3. TRANSCRANIAL MAGNETIC STIMULATION (TMS)
117
Q

Treatment of choice for MDD with severe suicidal ideation or food/drink refusal is __________

A

ELECTROCONVULSIVE THERAPY (ECT)

118
Q

Concerning continuity of care, end continuity of care when patient is not seeking health, T/F

A

FALSE

a commitment despite referral, death, failure or cure, and whether the patient is seeking health care or not

119
Q

Continuity of care does not include responsibility for preventive care, T/F

A

FALSE

includes responsibility for preventive care and care coordination

120
Q

Mention 5 benefits of Continuity of care

A
  1. It enhances a bond between the physician and patient characterized by loyalty, trust and sense of responsibility
  2. It enables the physician in detecting early signs and symptoms of organic disease and differentiating it from a functional problem
  3. Families receiving continuing comprehensive care have a decreased incidence of hospitalizations, fewer operations, and less physician visits for illnesses
  4. Continuity of care improves quality of life especially for those with chronic medical illnesses such as asthma and diabetes
  5. Care is less costly
121
Q

The transfer of responsibility from the original physician to another physician is consultation, T/F

A

FASLE

122
Q

Concerning referral, the transfer of responsibility should never be total, T/F

A

TRUE.

Well, in Collateral Referral there is transfer of complete responsibility for a limited period

123
Q

A physician that initiates a consultation is called _______

A

Referring Physician

124
Q

A physician that initiates a referral is called _______

A

Referring Physician

125
Q

A person who is consulted or to whom the patient is referred to is called ________

A

Consultant:

126
Q

Mention two types of consultations

A

Informal and Formal

127
Q

Telephone communication is not a part of Formal consultation, T/F

A

FASLE

May use telephone if consultation is urgent

128
Q

In informal consultation, the consultant and the doctor requesting consultation sees the patient together, T/F

A

FALSE.

Formal

129
Q

In formal consultation communication must be in writing, T/F

A

FALSE

Telephone communication may be used in cases of emergency

130
Q

Mention the 4 types of referral

A
  1. Interval referral
  2. Collateral referral
  3. Split referral
  4. Cross referral
131
Q

In Interval referrals, the patient is referred for care of some specific problem for a limited period, T/F

A

FALSE

referred for complete care for a limited period

132
Q

Concerning Interval referral, the referring physician has no responsibility during the limited period of referral, T/F

A

TRUE

133
Q

Concerning Collateral referral, the referring physician has no responsibility during the limited period of referral, T/F

A

FALSE

The referring physician retains overall responsibility

134
Q

In Collateral referral, the referring physician only refers the patient for care of some specific problem for a period of time, T/F

A

TRUE

135
Q

Which type of referral takes place under multispecialist practice

A

Split referral

Responsibility is divided evenly among two or more physicians

136
Q

In which type of referral does the referring physician accept no further responsibility

A

Cross referral

137
Q

Cross referral can only be initiated by the patient (self-referral), T/F

A

FALSE

Occurs after self referral by the patient or even after referral by the family physician

138
Q

Whenever the patient or family express doubt or shows lack of confidence in diagnosis or management is a reason for referral, T/F

A

TRUE

139
Q

A referral from Primary health care system to Secondary health care system is ________

A

Vertical referral

140
Q

A referral from a Tertiary health care system to a Tertiary health care system is ________

A

Horizontal referral

141
Q

A referral within the same institution (hospital) is called ________

A

Internal referral

142
Q

In referral, patients must be involved in decision making, T/F

A

TRUE

143
Q

Patients’ Irritability and stubbornness is a valid reason for referral, T/F

A

FALSE

Wrong reason

144
Q

Concerning the consultation process, it is not necessary for the family physician to provide feedback to the consultant regarding the outcome of his recommendation, T/F

A

FALSE

The family physician provides feedback to the consultant regarding the outcome

145
Q

Steps of referral process (hint: 8)

A
  1. Establish a good relationship with the patient.
  2. Establish the need for a referral.
  3. Set objectives for the referral.
  4. Explore resources availability.
  5. Patient decides to use or not use.
  6. Make pre-referral treatment.
  7. Facilitate, coordinate referral.
  8. Evaluate and follow up
146
Q

Mention the responsibilities of the referring physician (hint: 5)

A
  1. Selection of the consultant
  2. Adequate transfer of information
  3. Patient preparation and compliance
  4. Evaluation of information
  5. Feedback to consultants
147
Q

In selection of a consultant, the personality compatibility with the patient is important, T/F

A

TRUE

148
Q

Components of a Referral letter (hint: 12)

A
  1. Identifying data of the patient
  2. Identifying data of the referring physician
  3. Date
  4. Statement of the problem/PC
  5. Relevant history
    -Statement of the problem
    -PMHX/PSHX
    -Current drug Hx/allergies
  6. Relevant Examination findings
  7. Include results of relevant investigations
  8. Working assessment
  9. Describe treatment initiated
  10. State reason for referral
  11. State what information you have given to the patient regarding the referral.
  12. Indicate your willingness to be involved in the ongoing care of the patient
149
Q

Referrals and consultations should be subjective, T/F

A

FALSE

Objective

150
Q

The principles that guide referral and consultations are (hint: 3)

A

Objective, Timely/ prompt and individualized

151
Q

Diagnosis of Poisonings is primarily laboratory, T/F

A

FALSE

Diagnosis is primarily clinical, but for some poisonings laboratory investigations may be helpful

152
Q

What is Munchhausen syndrome by proxy

A

Parent, who may have some medical knowledge, poison their children because of unclear psychotic reasons or a desire to cause illness and thus gain medical attention

153
Q

Patients who ingest multiple substances (poisons) are less likely to have symptoms characteristic of a single substance, T/F

A

TRUE

154
Q

Inhaled toxins are likely to cause lower airway symptoms of non-cardiogenic pulmonary edema if they’re less water soluble, T/F

A

TRUE

155
Q

Inhaled toxins are likely to cause symptoms of upper airway injury if less water soluble, T/F

A

FALSE.

If water soluble

156
Q

SLUDGE syndrome is seen in Cholinergic (nicotinic) poisoning, T/F

A

FALSE

Cholinergic- muscarinic

157
Q

If blood levels of a substance or symptoms of toxicity increase after initially decreasing or persist for an unusually long time _____________ should be suspected

A

Bezoar, a sustained release preparation or re-exposure should be suspected

158
Q

Concerning poisonings, ________ is usually given particularly when multiple or unknown substances have been inngested

A

Activated Charcoal

159
Q

Mechanism of Activated Charcoal in mgt of ingested poisons

A

Activated Charcoal works adsorbing toxins

160
Q

Dose of Activated charcoal in
- younger children
- in Adults & older children

A

a dose of 1-2g/kg in children and 50-100g for older children and adults 4-6hourly as a slurry in water or soft drinks

161
Q

Use of charcoals adds little risk unless patients are at risk of ______ & _________

A

vomiting and aspiration

162
Q

Use of Activated charcoal is ineffective in ingestion of which toxins (hint: 3)

A

caustics, alcohols and ions

163
Q

Gastric emptying is contraindicated in ______ substance

A

Caustic substance

164
Q

The preferred method for gastric emptying in poisoning is ________

A

Gastric lavage

165
Q

__________ is indicated for serious poisons due to sustained release preparations or substances not adsorbed by charcoal such as heavy metals, packs of cocaine or for suspected bezoars

A

Whole Bowel Irrigation

166
Q

Solution used for whole bowel irrigation contains _______ & _______

A

polyethylene glycol (which is non absorbable) and electrolytes

167
Q

Concerning poisoning, general indications for Hospital Admission

A

 Altered consciousness
 Persistently abnormal vital signs
 Predicted delayed toxicity – slow release of toxins
 For Psychiatric evaluation

168
Q

Mention prevention of poisoning (hint:

A
  1. Use of child-resistant container with safety caps
  2. Clearly labeling household products and prescription drugs
  3. Storing drugs and toxic substances in SAFETY CABINETS that are labeled
  4. Promptly disposing expired medication e.g flushing them down the toilet.
  5. Use of Carbon monoxide detectors
  6. Public education measures to encourage storage of substances in their original containers not kerosene in sprite bottles
169
Q

The principal toxic metabolite of acetaminophen is __________

A

N-acetyl-P-benzo quinone imine (NAPQI)

170
Q

Concerning Acetaminophen toxicity/poisoning, an adult overdose must total 100mg/kg within 24hours, T/F

A

FALSE - 150mg/kg in 24hrs

To cause toxicity, an adult overdose must total = 150mg/kg (i.e about 7.5g in adults) within 24 hours (about 15 tabs)

171
Q

All patients with non-accidental ingestion of Acetaminophen overdose should be considered as attempted suicide, T/F

A

TRUE

Acetaminophen is commonly used for suicide

172
Q

Likelihood and severity of hepatotoxicity from Acetaminophen overdose can be predicted by __________ & _________

A

serum acetaminophen levels (accurately)
Rumack-Mathew nomogram (If time of ingestion is known)

173
Q

Antidote for Acetaminophen overdose is ________
and the dose (iv and Oral)

A

n-acetylcysteine

IV Loading dose of 150mg/kg in 200mls of 5% D/W given over 15 mins. Maintenance 50mg/kg in 500mls of 5% D/W over 8 hours then, 100mg/kg in 1000ml of 5% DW over 16 hours

Loading dose of 140mg/kg, then 17 additional doses of 70m/kg every 4 hours

174
Q

Treatment for Carbon monoxide poisoning

A

 Remove px from source of exposure
 Stabilize as necessary
 100% O2
 Supportive treatment

175
Q

Measurement of carboxy Hb levels __________

A

co-oximeter

Also with Arterial Blood gas

176
Q

Acid caustics cause coagulation necrosis, T/F

A

TRUE

177
Q

Alkali caustics cause coagulation necrosis, T/F

A

FALSE

Alkali Cause Liquefaction necrosis

178
Q

Between Acid caustics and Alkali caustics which is more corrosive?

A

Alkali caustics

Alkali Cause Liquefaction necrosis, no eschar forms, damage continues until alkali is neutralized or diluted

179
Q

Eschars are not formed with ingestion of Alkali caustics, T/F

A

TRUE

180
Q

Acid caustics affect esophagus more than stomach, T/F

A

FALSE
Acid caustics tend to affect the stomach more than the esophagus

181
Q

IV corticosteroids and prophylactic antibiotics are recommended in Caustic ingestions, T/F

A

FALSE

Not recommended

182
Q

Neutralization of Acid caustic ingestion is part of the treatment, T/F

A

FALSE

Attempts at neutralizing with alkali and vice versa is contraindicated, because severe exothermic reactions

183
Q

Activated charcoal is contraindicated in Caustic ingestions because of _________ & __________

A

Activated charcoal may infiltrate burned tissue and interfere with endoscopic evaluation

184
Q

Management of Caustic ingestion is mainly supportive, T/F

A

TRUE

185
Q

Antidote for Opioid is ____

A

Naloxone

186
Q

Antidote for Tricyclic antidepressants

A

NaHCO3

187
Q

Antidote for Metho haemoglobin

A

Methylene blue

188
Q

Antidote for Iron

A

Deferoxamine

189
Q

Antidote for Organophosphates

A

Atropine
Pralidoxime

190
Q

Antidote for Benzodiazepines

A

Flumazenil

191
Q

Definition of Family (hint: 4 lines)

A

A group of individuals who are related biologically, legally or by choice and from whom one reasonably expects a measure of support in form of food, clothing, shelter or emotional nurturing and who shares a past, present and future and includes all who contribute in one way or the other to the family culture

192
Q

A family group consisting of two people living together, ususally a woman & a man, without children is called?

A

Dyad family

193
Q

Family medicine is a primary care oriented specialty, T/F?

A

TRUE

194
Q

Define Family Medicine

A

A group of individuals who are related biologically, legally or by choice and from whom one reasonably expects a measure of support in terms of food, clothing, shelter or emotional nurturing and who shares a past, present and future and includes all who contribute in one way or the other to the family culture.

195
Q

Domains of Family medicine are (hint:3)

A

Hospital-based care, Family care & Primary care

196
Q

Khan’s 7-stars doctor (hint: picture the start)

A

Community leader, Communicator, Care provider, Decision maker/Advocate, Manager, Researcher, Coordinator

197
Q

Define Ageing

A

Ageing can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility

Ageing is a time related decline in the physiological functions necessary for survival and reproduction

198
Q

Reasons for rising ageing population (hint: 3)

A
  1. Breakthroughs in healthcare = increased life expectancy.
  2. People choosing to have smaller families.
  3. Falling birth rates:
    Later marriages
    Better education about contraceptives.
    increased number of women working.
199
Q

Classify ageing

A
  1. Objective
  2. Subjective
  3. Functional
200
Q

According to WHO, adult aged >65 is elderly, T/F

A

FALSE
WHO: adults aged ≥ 65 years

201
Q

List the concepts of ageing (hint: 5)

A
  1. CHRONOLOGIC AGEING (change in the no. of years lived)
  2. BIOLOGIC AGEING (changes in physiology)
  3. PSYCHOLOGIC AGEING (changes in behavior, personality & act)
  4. SOCIAL AGEING (changes in roles & relatonships)
  5. COGNITIVE AGEING (changes in the basic process of learning & memory)

Mnemonic: Biopsychosocial C^2

202
Q

Biologic/biological ageing is also called ______ or _____

A

Senescence or Physiologic ageing

203
Q

Social ageing is profoundly influence by the society’s culture, T/F

A

TRUE

204
Q

The two major categories of ageing theories are

A

The Programmed theories
The Damage of Error theories

205
Q

A major hallmark of ageing is a decrease in inflammatory levels reflected by lower levels of circulating pro-inflammatory cytokines, T/F?

A

FALSE.

Increased levels

206
Q

Hearing loss that occurs in ageing is usually to low frequency sound, T/F

A

FALSE
High frequency sounds

207
Q

Problem solving skills increase with age, T/

A

TRUE

208
Q

Intellectual functioning defined as “stored” memory decrease with age, T/F

A

FALSE.
Increases with age

209
Q

Emotions play a significant role in appetite & digestion, T/F

A

TRUE

210
Q

Orthostatic hypotension is relatively common in the elderly, T/F

A

TRUE

211
Q

The symptoms of climacteric period are typically present for about ____

A

5 years

212
Q

Autoimmue disorders increased in older adults, T/F

A

TRUE
increase in findings of positive
rheumatoid factor, anti-nuclear antibody, and false-
positive syphilis screens in healthy older adults

213
Q

Lipofusin is ageing pigment, TF?

A

TRUE

214
Q

Define Patient centered care

A

“providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” (Institute of Medicine (IOM) definition)

215
Q

Picker’s Eight (8) dimensions/principles/core values of Patient centered care
(hint: PACE CRII)

A

P - Physical comfort
A - Assess to care
C - Coordination and integration of care
E - Emotional support
C - Continuity and transition
R - Respect to patient’s preferences
I - Information and education
I - Involving friends and family

216
Q

Patient’s expectation is based on his/her understanding of the disease, T/F

A

TRUE

217
Q

Advantages of taking Illness experience or Actual Reasons for Coming (hint: 6)

A
  1. It will ensure patient’s satisfaction.
  2. It will reduce doctor/clinician shopping/hopping.
  3. It will reduce legal suits by angry patients.
  4. It will help physician’s ability to deal with patient’s needs for Education
  5. It helps with Reassurance
  6. It helps with Treatment
218
Q

Mention the 6 basic components of Patient centered care model

A
  1. Exploring & differentiating both the disease and the illness
  2. Understanding the whole person
  3. Finding common ground with the patient-mutual decisions (problems, goals, roles)
  4. Incorporating health promotion and disease prevention
  5. Enhancing doctor- patient relationship
  6. Being realistic with time and resources
219
Q

Concerning PCC, disease is mainly biological and ______

A

Psychological

220
Q

Concerning PCC, illness includes not just the biological and psychological aspect but also the _____ & ______

A

Social and Spiritual

221
Q

Tools used in understanding the whole person are (hint: 4)

A

family life cycle, family status, family genogram, family circle

222
Q

Disease prevention/reducing the risk of acquiring a disease can be achieved via (hint: 4)

A
  1. Risk avoidance
  2. Risk reduction
  3. Early identification
  4. Complication reduction
223
Q

All older person ages at the same rate, T/F

A

FASLE

HETEROGENEITY OF AGEING

224
Q

There is constriction of homeostasis (i.e., Homeostenosis) from ___ age

A

30years

With advancing age (from age of 30 years) there is constriction of homeostasis (HOMEOSTENOSIS)

225
Q

Beginning age of “Elderly”:
-WHO: adults aged: ___
-UN General Assembly: ____
-Developed Countries: ___
-Less developed areas esp SSA: ___

A

WHO: adults aged ≥ 65 years
UN General Assembly: ≥ 60 years
Developed Countries: ≥ 65 years
Less developed areas esp SSA: ≥ 60 years

226
Q

The Global Agewatch index ranks countries by how their older populations are faring using key indices (hint: 4)

A
  1. Income security
  2. Health Status
  3. Capability
  4. Enabling societies and environment
227
Q

Care of the Elderly is longitudinal, T/F

A

TRUE

228
Q

Comprehensive Geriatric assessment is multidimensional. the 4 domains (4 most important areas of care) assessed are

A
  1. Functional ability
  2. Physical health
  3. Mental health/cognition
  4. Socio-environmental
229
Q

Health characteristics of the elderly (hint: 7)

A
  1. Multiple morbidities
  2. Atypical presentation of diseases
  3. Multiple pathologies causing a particular disease
  4. More complications arising from diseases
  5. Prolonged hospital stay
  6. Poor recovery from diseases
  7. Deranged social factors
230
Q

The differences of elderly assessment from standard medical evaluation (hint: 3)

A
  1. Including non-medical domains
  2. Emphasis on functional capacity and quality of life
  3. Incorporating a multidisciplinary team
231
Q

GERIATRIC GIANTS- The 14 I’s

A
  1. Intellectual impairment
  2. Insomnia
  3. Impaired hearing
  4. Impaired vision
  5. Impaction
  6. Incontinence
  7. Impotence
  8. Instability- falls
  9. Immobility -
  10. Inanition
  11. Immune-deficiency
  12. Infection
  13. Iatrogenia
  14. Isolation
232
Q

Define functional status

A

Functional status refers to a person’s ability to perform tasks that are required for living.

233
Q

The two (2) key divisions of functional ability

A
  1. Basic activities of daily living (BADL)
  2. Instrumental activities of daily living (IADL)
234
Q

self-care activities that a person performs daily is called ______

A

Basic activities of daily living (BADL)

235
Q

What tool is used to assess the Basic activities of daily living (BADL)

A

The Katz index questionnaire

236
Q

List the Basic activities of daily living (BADL)

A

Continence
Toileting
Bathing
Dressing
Feeding
Transferring

237
Q

The highest scores in the Ketz index is ____

A

6

238
Q

_______ activities are activities that are needed to live independently

A

Instrumental activities of daily living (IADL)

239
Q

_____ tool aids in assessing the Instrumental activities of daily living (IADL)

A

Lawton- Brody instrumental tool

240
Q

For the Physical health assessment of the elderly, special topics includes (hint: 6)

A
  1. Nutrition
  2. Vision
  3. Hearing
  4. Fecal and urinary continence
  5. Balance and fall prevention, osteoporosis
  6. and Polypharmacy
241
Q

Coomon causes of vision impairment in the elderly (hint: 4)

A

Presbyopia,

glaucoma,

diabetic retinopathy,

cataracts.

242
Q

In Diabetic retinopathy, there is blurring of the peripheral vision to blindness, T/F

A

FALSE

Blurring of central vision to blindness

243
Q

In Glaucoma, there is loss of central vision, T/F

A

FALSE

Loss of peripheral or “side” vision

244
Q

Most common type of hearing loss in the elderly is ______

A

Presbycusis

245
Q

What tool is used to assess patient’s risk of falls

A

The Tinetti Balance and Gait Evaluation

FAMILY MEDICINE (7 decks)

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