exam Flashcards
(329 cards)
1
Q
children under 12 presentingw/ unexplained somatic sxs, restlessness, separation anxiety, phobias or hallucinations
A
screen for depression
2
Q
level of evidence:
children living in areas w/ inadequate fluoride in water supply should take a daily fluoride supplement
A
evidence B
3
Q
level of evidence:
school aged children should receive age-appropriate immunizations as well as catch-up immunization if needed
A
level A
4
Q
level of evidence:
scholl aged children should be screened for obesity by measuring BMI. those w/ obesity (>95) should be offered resources and referral for comprehensive, intensive behavioral interventions
A
level B
5
Q
Fluoride supplementation:
Age 3-6 years
- .6
A
- .5
- .3-.6–> .25
- > .6–> none
6
Q
Fluoride supplementation:
Age 5-16 years
- .6
A
- 1.0
- .3-.6– > .5
- > .6–> none
7
Q
USPTSTF in school-aged children recommendation for dyslipidemia?
A
insufficient evidence
8
Q
USPTSTF school-aged children recommendation for hearing
A
none
9
Q
USPTSTF school-aged children recommendation for HTN
A
insufficient evidence
10
Q
USPTSTF school-aged children recommendation for obesity
A
beginning at age 6
11
Q
USPTSTF school-aged children recommendation for scoliosis
A
insufficient evidence
12
Q
USPTSTF school-aged children recommendation for social determinants of health
A
none
13
Q
USPTSTF school-aged children recommendation for vision
A
none
14
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for depression screening
A
screen adolescents 12 years and older
15
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for alcohol use screening
A
insufficient evidence
16
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for drug use screening
A
insufficient evidence
17
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for tobacco use screening/counseling
A
provide interventions, including education or brief counseling to prevent tobacco use
18
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for STI counseling
A
counseling is recommended in patients who are sexually active,
19
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for chlamydia/Gonorrhea screening
A
screen sexually active females younger than 25 years annually
20
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for HIV screening
A
begin screening at 15 yo of age or younger in those at increased risk of infection
21
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for Syphilis screening
A
screening is strongly recommended in patients at increased risk of infection
22
Q
USPTSTF for high-risk behaviors in school-aged children/adolescents recommendation for physical activity
A
at least 60 minutes of physical activity per day
23
Q
level of evidence:
sexually active females younger than 25 should be screened for chlam/gono annually. Adolescents w/ multiple partners or high-risk sexual behavior should be screened for syphilis and HIV. All adolescents should be screened for HIV beginning at 15 yo of age
A
level A
24
Q
level of evidence :
school aged children should be taught safety precautions and parents should be encouraged to model safe behaviors
A
level B
25
level of evidence :
Adolescents 12 years and older should be screened for major depressive disorder using a validated tool such as the patient health questionnaire for adolescents and the beck depression inventory for primary care.
level B
26
level of evidence:
sexually active adolescents should receive intensive behavioral counseling on the prevention of sexually transmitted infections
level B
27
recommendation and level?
Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years
B- The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
28
recommendation and level for cervical cancer screening?
| Women aged 21 to 65 years
A- The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).
29
recommendation and level for ovarian cancer screening?
Asymptomatic women
D- The USPSTF recommends against screening for ovarian cancer in asymptomatic women. This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.
30
recommendation and level for prostate cancer screening?
| Men aged 55 to 69 years
C- For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one.
31
recommendation and level for colorectal cancer screening?
A- The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. The risks and benefits of different screening methods vary. See the Clinical Considerations section and the Table for details about screening strategies.
32
recommendation and level for breast cancer screening?
| Women aged 50 to 74 years
B- The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
33
4 principles of motivational interviewing
REAL
1. righting reflex
2. empathy
3. ambivalence
4. listen in order to understand and empower
34
Prochaska's 5 Stages of Change
1. Pre-contemplative
2. Contemplative
3. Preparation
4. Action
5. Maintenance/Relapse
35
level of recommendations:
advise parents of a child diagnosed with autism spectrum disorder that early intensive behavioral therapy can improve cognitive language and adaptive skills
level A
36
ASD affects approx. __________ children in USA according to the CDC
1/68
37
ASD mnemonic: ALARM
```
Autism is prevalent
Listen to parents
Act early
Refer
Monitor
```
38
Therapeutic options for ASD
all are effective except? level A recommendation:
1. early intensive behavioral therapy
2. Melatonin for sleep disturbance
3. secretin IV
4. Parent-mediated early intervention
5. risperidone for behavioral issues
Secretin IV
39
TECHNIQUE TO EXAMINE JOINT:
```
“IPASS”
Inspection
Palpation
Active Range of Motion
Strength
Special Tests
```
40
is one of the most common causes of anterior knee pain encountered in the outpatient setting in adolescents and adults younger than 60 years.
Patellofemoral pain syndrome (PFPS)
41
The cardinal feature of PFPS is
pain in or around the anterior knee that intensifies when the knee is flexed during weight-bearing activities.
42
The pain of PFPS often worsens/improves? with prolonged sitting or descending stairs. The most sensitive physical examination finding is______________
The pain of PFPS often worsens with prolonged sitting or descending stairs. The most sensitive physical examination finding is pain with squatting.
43
Plain radiographs for diagnosis of PFPS?
Plain radiographs of the knee are not necessary for the diagnosis of PFPS but can exclude other diagnoses, such as osteoarthritis, patellar fracture, and osteochondritis.
44
treatment of PFPS?
Treatment of PFPS includes rest, a short course of nonsteroidal anti-inflammatory drugs, and physical therapy directed at strengthening the hip flexor, trunk, and knee muscle groups. Patellar kinesiotaping may provide additional short-term pain relief; however, evidence is insufficient to support its routine use. Surgery is considered a last resort.
45
level of recommendation
Exercise therapies are most effective in improving short- and long-term pain in patients with patellofemoral pain syndrome.
A
46
level of recommendation:
Short courses of nonsteroidal anti-inflammatory drugs improve pain in patients with patellofemoral pain syndrome compared with placebo, but the effect may be limited to one week.
B
47
level of recommendation:
Patellar kinesiotaping improves patellar maltracking and may reduce short-term pain as an adjunct to exercise.
B
48
Common acute shoulder injuries include
1. acromioclavicular joint injuries,
2. clavicle fractures,
3. glenohumeral dislocations,
4. proximal humerus fractures,
5. rotator cuff tears
49
Acromioclavicular joint injuries and clavicle fractures mostly occur in
young adults as the result of a sports injury or direct trauma.
50
Most nondisplaced or minimally displaced injuries can be treated _________
conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed.
51
Glenohumeral dislocations can result from _______________.
Patients will usually hold the affected arm in their contralateral hand and have pain with ____ and ______ motion at the shoulder.
Physical findings may include a ________________ or ____________________
Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma.
Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder.
Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally.
52
Reduction maneuvers usually require ____________
intra-articular lidocaine or intravenous analgesia.
53
Proximal humerus fractures often occur in _________________
Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training.
older patients after a low-energy fall.
Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training.
54
Radiography of the shoulder should include a true anteroposterior view of the(3)
1. glenoid,
2. scapular Y view,
3. and axillary view.
55
Rotator cuff tears can cause difficulty with ____________ or pain that ________________.
On physical examination, patients may be _____________________________
Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep.
On physical examination, patients may be unable to hold the affected arm in an elevated position.
56
level of recommendation:
Decisions about conservative vs. surgical treatment of acute middle one-third clavicle fractures should be individualized, considering the relative benefits and harms of each intervention and patient preferences.
B
57
level of recommendation:
Surgery should be considered in young athletes with shoulder dislocations because of a high recurrence rate in these patients
B
58
level of recommendation:
Older patients with proximal humerus fractures can be treated nonoperatively because these patients have equivalent or better outcomes compared with those who have surgery.
B
59
level of recommendation:
| The effectiveness and safety of surgery for chronic rotator cuff disease in older patients are unclear.
B
60
10 IMPORTANT ASPECTS OF CARE TO CONSIDER WHEN CARING FOR THE HOMELESS
1. BE RESPECTFUL
2. WITHHOLD JUDGMENT
3. MODIFY THE GUIDELINES
4. CONTACT INFORMATION:
5. FOOT CARE:
6. IDENTIFICATION AND INSURANCE:
7. KNOW WHEN PEOPLE HAVE MONEY:
8. GET TO KNOW YOUR PATIENT’S NARRATIVE:
9. MOVE AT THE PATIENT’S PACE
10. MODIFY THE MEDICATIONS YOU PRESCRIBE
61
Homeless med consideration:
| albuterol
Enhances effects of crack cocaine
62
Homeless med consideration:
| benzo
Sought for calming and sedating effects
63
Homeless med consideration:
| beta blockers and clonidine
Should be prescribed with caution, because discontinuing these medications suddenly can result in serious rebound hypertension
At initiation, beta blockers can exacerbate depression
Clonidine can be misused by persons with chemical dependencies to prolong the effects of heroin and other opioids
64
Homeless med consideration:
| buproprion (wellbutrin)
Can be pulverized and snorted to get high
65
Homeless med consideration:
CCB, Cox-2, NSAIDs, diabetic med.
May exacerbate heart failure
66
Homeless med consideration:
| diuretics
Can exacerbate dehydration, particularly in warmer climates, for persons with limited access to water
67
Homeless med consideration:
| anticholinergic medications in combination w/ diuretics
Can cause dangerous (even fatal) hyperpyrexia in hot, humid environments without adequate hydration
68
Homeless med consideration:
| drugs metabolized in liver
Problematic in persons with chronic hepatitis from intravenous drug and alcohol abuse
69
Homeless med consideration:
| pseudoephedrine
Can be used to make methamphetamine
70
Homeless med consideration:
Quetiapine- seroquel
Enhances effects of heroin
71
Homeless med consideration:
Statins
May worsen health outcomes in persons with chronic elevation of liver transaminase levels secondary to hepatitis B or C or in persons with long-term alcohol abuse
72
Homelessness affects men, women, and children of all races and ethnicities. On any given night, more than _______________ persons in the United States are homeless; a little more than ______________ of these are families. Homeless persons are more likely to become ill, have greater hospitalization rates, and are more likely to die at a younger age than the general population. The average life span for a homeless person is between _______________
Homelessness affects men, women, and children of all races and ethnicities. On any given night, more than 610,000 persons in the United States are homeless; a little more than one-third of these are families. Homeless persons are more likely to become ill, have greater hospitalization rates, and are more likely to die at a younger age than the general population. The average life span for a homeless person is between 42 and 52 years.
73
medical abortion w/ Mife/Miso vs Aspiration abortion:
gestational age
1. medications abortion-- currently up to 11 wks
2. Aspiration- 14-16wks +
D&E- beyond 16wks
74
medical abortion w/ Mife/Miso vs Aspiration abortion:
| Advantages
1. medications abortion-- natural, location control
| 2. Aspiration- over in 5-10 min, leaved office not pregnant, less post-procedure bleeding
75
medical abortion w/ Mife/Miso vs Aspiration abortion:
| disadvantages
1. medications abortion-- multiple days, heavier and longer bleedings, fetus may be present
2. Aspiration- requires clinical setting, instrumentation, anesthesia,
76
medical abortion w/ Mife/Miso vs Aspiration abortion:
| effectiveness
1. medications abortion <63 days is 95-99% and if fails needs aspiration
2. Aspiration- over 99%
77
% of abortions
18 in 2017
78
medical abortion w/ Mife/Miso vs Aspiration abortion:
| safety
1. medications abortion used safely for >25 years... at least 10 fold safer than continuing a pregnancy to term
2. Aspiration- used safely for >45 years... at least 10 fold safer than continuing a pregnancy to term
79
physicians can use the five A's framework to promote smoking cessation.
1. ask,
2. advise,
3. assess,
4. assist,
5. arrange
80
Office systems should ensure that all tobacco users are identified; smoking status should be documented at every visit
ask
81
Unambiguous support for smoking cessation should be expressed by the physician, and the benefits of quitting should be discussed
advise
82
Willingness to quit and barriers to quitting should be assessed, as well as smoking history and current level of nicotine dependence; patients should be asked about their timeline for quitting and about previous attempts
assess
83
Offer support and additional resources (e.g., referral to counseling, http://www.smokefree.gov, 1-800-QUIT-NOW, pharmacotherapy); help patients to anticipate difficulties and encourage them to prepare their social support systems and their environment for the impending change
Withdrawal: Common nicotine withdrawal symptoms (e.g., irritability, anxiety, restlessness) peak within the first week of abstinence and last two to four weeks; NRTs can be helpful because they gradually decrease nicotine dependence; smokers should also be advised to decrease caffeine intake*
Depression: Smokers are more likely than nonsmokers to have a depressive episode,12 and smokers with depression are less likely to successfully quit13; smoking cessation may trigger depression in those with a history of depression14; physicians should consider monitoring the mood of smokers during quit attempts and screen for depression in those who have repeatedly been unable to quit; bupropion (Zyban) may be an appropriate cessation aid for smokers at risk of depressive relapse
Weight gain: Although most smokers gain fewer than 10 lb (4.5 kg) after quitting, weight gain can vary (10 percent will gain 30 lb [13.5 kg])15; although this weight gain poses less health risk than smoking, concern about weight gain may interfere with the quit attempt; sustained-release bupropion or an NRT (particularly gum or lozenges) may be helpful in these patients because they delay weight gain while in use4; it may be easier to monitor and adjust food intake/exercise balance after immediate tobacco cravings are no longer as prominent
Assist
84
Follow-up plans should be set; for patients who have recently quit, it is important to elicit the benefits of quitting and ask patients to anticipate and problem solve about situations that might lead to relapse; follow-up contacts should also be used to readjust the dosages of therapeutic agents that may be altered by smoking cessation (e.g., beta blockers, antipsychotics, insulin, benzodiazepines)*
Arrange
85
No intention to take action within the foreseeable future (next six months)
Pre-contemplation
86
Considering change within the next six months
Contemplation
87
Planning to take action within the next month
Preparation
88
Actively changing (first six months of new behavior)
Action
89
More than six months since behavior change
Maintenance
90
The success rate of smoking cessation of
1. varenicline(chantix)
2. Buproprion (wellbutrin, Zyban)
3. Nicotine replacement therapy (NRT)
4. Support programs
1. varenicline(chantix)-- 26%
2. Buproprion (wellbutrin, Zyban)--20%
3. Nicotine replacement therapy (NRT)-- 14-19%
4. Support programs-- unknown
91
Side effects of varenicline
Nausea, intense dreams, agitation, SI
92
side effects of bupropion
dry mouth, agitation, lower seizure threshold, SI
93
side effects NRT
headaches, dizziness, drowsiness, skin irritation, sore throat, bad taste
94
smoking cessation match:
| unknown-- an antidepressant which seems to reduce pyshcological craving of smoking
bupropion
95
smoking cessation match:
nicotine partial agonist, binds receptors so that empty receptors dont trigger cravings and so nicotine that is used has no physical effect. works by reducing cravings and taking the fun out of smoking
chantix
96
smoking cessation match:
nicotine replacement to allow breaking the mental habit while not suffering nicotine withdrawal. Then gradually decrease the amount of nicotine
NRT
97
can you combine chantix w/ support, bupropion and NRT?
yes
98
rank most expensive to least for smoking cessation meds
chantix- 180
bupropion- 75-100
NRT- 100
99
Altmans' rule
g protein + g fiber > g sugar
| ** 3g fiber minimum
100
What does the dash diet show?
significant drop in BP within 2 wks
101
what did the lyon Mediterranean study show
72% cardiovascular event reduction for secondary prevention
102
what did the predimed primary prevention study show
>28% cardiovascular event reduction-- strokes
103
how do diet and lifestyle compare with medication for pre-diabetes?
diet and physical activity reduced the risk of developing diabetes by 58% compared to 31% with metformin
104
can you halt the progression of heart disease with diet and lifestyle?
yes
105
does diet add incremental value to medication?
yes
106
nuts?
consider incorporating one handful of nuts every other day as a snack
107
cooking oil?
avoid reacing smoking point
108
most biologically active forms of OMEGA-3
EPA and DHA
109
sources rich in ALA
flaxseed
walnuts
chia
110
daily fiber goal
30g
111
____ a flat lesion (< 1cm) that you cannot feel
____ a flat lesion (> 1cm) that you cannot feel
____ a raised lesion (< 1cm) that you can feel
_____ a raised lesion (> 1cm) that you can feel
______ a palpable lesion (< 2cm) within the dermis or subcutis (rather than in the epidermis)
_______ a palpable lesion (> 2cm) within the dermis or subcutis (rather than in the epidermis)
Macule: a flat lesion (< 1cm) that you cannot feel
Patch: a flat lesion (> 1cm) that you cannot feel
Papule: a raised lesion (< 1cm) that you can feel
Plaque: a raised lesion (> 1cm) that you can feel
Nodule: a palpable lesion (< 2cm) within the dermis or subcutis (rather than in the epidermis)
Tumor: a palpable lesion (> 2cm) within the dermis or subcutis (rather than in the epidermis)
112
ABCDE's of melanoma
```
Asymmetry
Border is irregular
Color is mixed
Diameter is larger than 6 millimeters
Evolves over time
```
113
level of recommendations
| Intralesional steroids are first-line therapy for keloids.
B
114
```
Fitzpatrick skin types
I
II
III
IV
V
VI
```
```
I- always burn, never tan
II- always burn, but sometimes tan
III- sometimes burn, but always tan
IV- never burn, always tan
V- moderately pigmented skin
VI- darkly pigmented skin
```
115
Rash?
Trunk, spreads peripherally
Macular to maculopapular
High fever, usually greater than 102°F (39°C), precedes the rash; child is otherwise well-appearing
No
Can be confused with measles; measles rash begins on the face, and the child is usually ill-appearing
1 to 2 days
Roseola infantum (exanthema subitum)
116
Rash?
Trunk, bilateral and symmetric, Christmas tree distribution
Herald patch on the trunk may present first, followed by smaller similar lesions; oval-shaped, rose-colored patches with slight scale
No
Occurs in up to one-half of patients
Often confused with tinea corporis; pityriasis rosea is typically widespread, whereas tinea corporis usually causes a single lesion
2 to 12 weeks
Pityriasis rosea
117
Rash?
Upper trunk, spreads throughout body, spares palms and soles
Erythematous, blanching, fine macules, resembling a sunburn; sandpaper-like papules
Occurs 1 to 2 days before rash develops
Usually no
Petechiae on palate; white strawberry tongue; test positive for streptococcal infection
Several weeks
Scarlet fever
118
Rash?
Anywhere; face and extremities are most common
Vesicles or pustules that form a thick, yellow crust
Usually no
No
May be a primary or secondary infection; bullous form is typical in neonates, and nonbullous form is more common in preschool- and school-aged children
Usually self-limited but often treated to prevent complications and spread of the infection
Impetigo
119
Rash?
Face and thighs
Erythematous “slapped cheek” rash followed by pink papules and macules in a lacy, reticular pattern
Low grade
Yes
May be confused with scarlet fever; the slapped cheek rash can differentiate erythema infectiosum
Facial rash lasts 2 to 4 days; lacy, reticular rash may last 1 to 6 weeks
Erythema infectiosum (fifth disease)
120
Rash?
Anywhere; rarely on oral mucosa
Flesh-colored or pearly white, small papules with central umbilication
No
Yes, if associated with dermatitis
Usually resolves spontaneously without treatment
Months or up to 2 to 4 years
Molluscum contagiosum
121
rash?
Anywhere
Alopecia or broken hair follicles on the scalp (tinea capitis), erythematous annular patch or plaque with a raised border and central clearing on the body (tinea corporis)
No
Yes
Often confused with pityriasis rosea; potassium hydroxide microscopy can help confirm diagnosis
Usually requires antifungal treatment
Tinea infection
122
Rash?
Extensor surfaces of extremities, cheeks, and scalp in infants and younger children; flexor surfaces in older children
Erythematous plaques, excoriation, severely dry skin, scaling, vesicular lesions
No
Yes
Emollients and avoidance of triggers are the mainstay of treatment; topical corticosteroids may be needed for flare-ups
Chronic, relapsing
Atopic dermatitis
123
3 most common cause of cough?
1. Asthma
2. GERD
3. Post-nasal drip
124
Nerve root compression causing urinary retention, bilateral weakness, saddle anesthesia.
Neuro-surgical emergency
Caused by massive midline disc herniation
Prevalence among all with LBP: 0.0004
Cauda Equina syndrome
125
Onset <40 years old, gradual onset
Pain duration >3 months
Morning stiffness
Improved by exercise
Ankylosing spondylitis
126
Pseudoclaudication
Leg pain on walking
Relieved by sitting or standin
Spinal stenosis
127
History of osteoporosis
Corticosteroid use
Trauma
Elderly
compression fracutre
128
Failure to improve (>6 weeks)
Prior history of cancer
Unexplained weight loss
Cancer
129
true or false?
Routine spinal imaging tests are NOT indicated. Imaging tests are indicated in the setting of red flags (refer to below) or severe problems persisting beyond 1 month.
true
Most back problems improve spontaneously; therefore, conservative management is almost always indicated.
130
The most important therapeutic instrument is __________
patient education.
131
level of recommendation
| Acupuncture provides benefits for chronic low back pain.
A
132
level of recommendation
| Coenzyme Q10 is a safe adjunctive therapy in patients with heart failure and may improve clinicaloutcome
B
133
level of recommendation
| Exercise has a small to moderate effect in reducing symptoms in persons with diagnosed anxiety disorders.
B
134
level of recommendation Ginkgo biloba extract EGb 761 improves cognition in patients with dementia
A
135
level of recommendation
| Cognitive behavior therapy is effective for the treatment of insomnia.
A
136
level of recommendations
| Music is effective for improving subjective sleep quality in adults with insomnia.
B
137
level of recommendation
Movement-oriented mind-body approaches such as yoga, tai chi, and qi gong may be beneficial for sleep, especially in older adults and cancer survivors.
A
138
level of recommendation
| Probiotic supplementation significantly reduces the incidence of antibiotic-associated diarrhea.
A
139
level of recommendations
| St. John's wort (Hypericum perforatum) benefits patients with mild to moderate depression.
A
140
Acupuncture for Chronic low back pain
First-line or adjunctive?
first line
141
Coenzyme Q10 for Heart failure
First-line or adjunctive?
adjunctive
142
Exercise for Anxiety
First-line or adjunctive
first line
143
Fish oil for Hypertriglyceridemia
First-line or adjunctive?
first line
144
Ginkgo biloba for Dementia
First-line or adjunctive?
first line
145
Mind-body interventions for Insomnia
First-line or adjunctive?
first line
146
Probiotics for Prevention of antibiotic-associated diarrhea
First-line or adjunctive?
first line
147
St. John's wort for Depression
First-line or adjunctive?
first line
148
Does Epidural steroid injections improve pain or disability in patients with spinal stenosis?
Epidural steroid injections do not improve pain or disability in patients with spinal stenosis
149
Spinal manipulation therapy produces small benefits for up to ________
six months.
150
level of recommendation:
Do not order imaging studies unless there is concern for infection, fracture, or cauda equina syndrome, or unless required before invasive interventions.
A
151
level of recommendation:
NSAIDs, opioids, and topiramate (Topamax) are more effective than placebo in the short-term treatment of nonspecific chronic low back pain.
A
152
level of recommendations :
Acetaminophen, antidepressants (except duloxetine [Cymbalta]), skeletal muscle relaxants, lidocaine patches, and transcutaneous electrical nerve stimulation are not more effective than placebo in the treatment of chronic low back pain.
B
153
level of recommendation:
Epidural steroid injections are not more effective than placebo for long-term relief of chronic back pain from various causes.
B
154
level of recommendation:
Spinal manipulation therapy results in small improvements in pain and function in chronic low back pain for up to six months.
B
155
level of recommendations:
Nonsteroidal anti-inflammatory drugs, acetaminophen, and muscle relaxants are effective treatments for nonspecific acute low back pain.
A
156
level of recommendation:
Patient education that includes advice to stay active, avoid aggravating movements, and return to normal activity as soon as possible and a discussion of the often benign nature of acute low back pain is effective in patients with nonspecific pain.
B
157
level of recommendations:
Although regular exercises may not be beneficial in the treatment of nonspecific acute low back pain, physical therapy (McKenzie method and spine stabilization) may lessen the risk of recurrence and need for health care services.
B
158
level of recommendations
Spinal manipulation and chiropractic techniques are no more beneficial than established treatments for nonspecific acute low back pain, and their addition to established treatments does not improve outcomes.
B
159
level of recommendation:
| Bed rest is not helpful for nonspecific acute low back pain.
A
160
For acute low back pain T or F?
No substantial benefit has been shown with oral steroids, acupuncture, massage, traction, lumbar supports, or regular exercise programs.
True
161
level of recommendation:
Patients taking long-acting opioids for chronic nonmalignant pain should be started on long-term preventive therapy with a combination stimulant/softener laxative for constipation.
B
162
level of recommendation:
| Multicomponent prevention methods are effective in deterring delirium episodes.
B
163
level of recommendations:
Antipsychotic medications should be used as a last resort in treating delirium and should not be used indiscriminately in persons with delirium who have not been properly evaluated.
A
164
_________is defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition.
Delirium
165
progressive decline in memory, higher cortical function, and personality change interference w/ social activities, relationships.
dementia
166
most common cause of dementia
alzheimers
167
delirium or dementia?
disorientation agitation?
dementia
168
rapid screening tool for mild cognitive impairment, a state between normal cognitive aging and dementia
MoCA
total possible score is 30 w/ 26 or above normal
169
which one is more sensitive MoCA or MMSE for detecting MCL and Alzheimers
MoCA
170
Mini Cog is used for ?
confusion assessment method for delirium
171
The AGS Beers Criteria® include the same five main categories as in 2015:
(1) potentially inappropriate medications in older adults; (2) potentially inappropriate medications to avoid in older adults with certain conditions; (3) medications to be used with considerable caution in older adults; (4) medication combinations that may lead to harmful interactions; and (5) a list of medications that should be avoided or dosed differently for those with poor renal function.
172
The goal of treatment in asthma is to prevent symptoms by
reducing airway inflammation and hyperreactivity.
173
Asthma-Multiple randomized controlled trials have shown that _______________ are the most effective monotherapy
inhaled corticosteroids
174
second line for asthma
Long-actin beta agonists
175
Patients with mild persistent asthma who prefer not to use inhaled corticosteroids may use ________________ as monotherapy, but they are less effective.
leukotriene receptor antagonists
176
Because of their high cost and a risk of anaphylaxis, __________________________should be reserved for patients with severe symptoms not controlled by other agents.
monoclonal antibodies
177
______________ should be considered in persons with asthma triggered by confirmed allergies if they are experiencing adverse effects with medication or have other comorbid allergic conditions. Many patients with asthma use complementary and alternative agents, most of which lack data regarding their safety or effectiveness.
Immunotherapy
178
level of recommendations
Inhaled corticosteroids improve asthma control and quality of life and reduce asthma symptom severity, systemic steroid use, emergency department visits and hospitalizations, and deaths.
A
179
level of recommendation:
Long-acting beta2 agonists are effective for control of persistent asthma symptoms and are the preferred agents to add to inhaled corticosteroids in patients 12 years and older, but they are not recommended for use as monotherapy
A
180
level of recommendation:
Leukotriene receptor antagonists can be used as adjunctive therapy with inhaled corticosteroids, but they are less effective than long-acting beta2 agonists in patients 12 years and older.
B
181
Level of recommendation:
If adequate symptom control is not attained with low-dose inhaled corticosteroids, either increasing the inhaled steroid dosage or adding a long-acting beta2 agonist to therapy is appropriate according to current guideline recommendations.
B
182
True or False
| Do not diagnose or manage asthma without spirometry.
true
183
Otitis media caused by?
Common Bugs: S. Pneumo, H. Flu
184
otitis media tx.
Amox
Consider no Rx and f/u prn (if >6 mo)
185
Acute sinusitis bugs
Common Bugs: S. Pneumo, H. Flu
186
Acute sinusitis tx
1st Line: Amox (consider double dose), Levofloxacin if resistant
187
Pharyngitis common bugs
Group A strep
188
Pharyngitis tx.
first line--PCN
| Erythromycin if PCN allergy Amox in kids
189
Pneumonia common bugs
Common Bugs: S. Pneumo, Atypicals, H. Flu
190
Pneumonia tx
1st Line: macrolide, doxycycline
Consider Levofloxacin if refractory,
Pt. is elderly, pt. has co-morbidities
191
GU UTI common bugs
Common Bugs: E. Coli, other Gram negs, S. Saphrophyticus
192
UTI tx.
1st Line: Macrobid, Bactrim
| Cipro (second line)
193
Pseudomembranous Colitis
| Common Bugs
Common Bugs: C. Difficile
194
Pseudomembranous Colitis tx.
1st Line: PO Vanco or fidaxomicin
195
GI Tract Infections
Traveller’s Diarrhea
Common Bugs
Common Bugs: E. Coli, Salmonella, Shigella, Campylobacter, Parasite
196
GI Tract Infections
| Traveller’s Diarrhea tx. for bacteria
1st Line (Bacterial): Cipro initiate if Sx’s >24 hours, fever, bloody diarrhea;
Single-dose azithromycin for kids
197
GI Tract Infections
| Traveller’s Diarrhea Tx.for (Giardia, Entamoeba)
1st Line :Metronidazole
198
STI’s tx.
Chlamydia
Gonorrhea
STI’s
Chlamydia: Azithro po
Gonorrhea: Ceftriaxone IM
Partner(s) must be treated
199
Vaginitis tx.
Candida:
Bacterial Vaginosis:
Trichomonas:
Candida: OTC antifungals or Fluconazole
Bacterial Vaginosis: Flagyl
Trichomonas: Flagyl (treat partner)
200
Acne tx
1st Line: Doxy (Beware of photosensitivity rxn)
201
Cellulitis/Impetigo/Abscess TX
1st line?2nd line?
Drain Abscess?
MRSA?
1st line Diclox/Keflex
2nd line: Clinda
Drain Abscess, Can use Bactroban for impetigo;
MRSA: Bactrim, Doxy
202
Penicillins SE:
GI upset, allergic reaction (rash, anaphylaxis), yeast infection, ↓ seizure threshold, C. diff colitis
203
Macrolides SE: .
GI upset, allergic rxn (rare), yeast infxn, C. diff colitis.↑QT interval when combined w/ azoles (anti-fungals). Drug interxns: can increase levels of other drugs by inhibiting p450
204
Cephalosporins SE:
GI upset, allergic reaction (5% cross-allergenicity with PCN), yeast infection C. diff colitis
205
Tetracyclines SE:
GI upset, photosensitivity rash, allergic rxn, C. diff colitis, yeast infection, bone/teeth discoloration: avoid < 8 yo, pregnant
206
Trimethoprim/SulfamethoxizoleLinks to an external site.
| SE:
Allergic reaction (rash, Steven’s Johnson Syndrome), GI upset, yeast infxn, C. diff colitis, E. multiforme, Anemia with G-6PD deficiency
207
Metronidazole (Flagyl)Links to an external site.
| SE :
disulfiram-like rxn (severe GI upset w/ EtOH), GI upset, metallic taste, allergic rxn
208
ClindamycinLinks to an external site. SE:
GI upset, allergic rash, yeast infection,
| C. diff colitis
209
Fluoroquinolones
| SE:
GI upset, allergic rxn (1%), HA, yeast infection, C. diff colitis. Damages developing cartilage: avoid in pregnacy, kids
210
level of recommendation
Over-the-counter cold medications should not be used in children younger than four years because of potential harms and lack of benefit.5
B
211
level of recommendation
| The use of hand sanitizer or hand washing is the most effective way to prevent the common cold.8
B
212
level of recommendation
Treatments with established effectiveness for cold symptoms in adults are limited to over-the-counter analgesics and decongestants with or without antihistamines (but not antihistamine monotherapy)
B
213
level of recommendation :
| Antibiotics are ineffective for treatment of the common cold in adults and children and should not be prescribed
A
214
level of recommendation:
| Codeine and other antitussives have not been proven effective for cough in adults.
B
215
level of recommendation: Safe and effective treatments for cold symptoms in children include nasal saline irrigation, menthol rub, and honey (for children 12 months and older).
B
216
what treatment might benefit w/ Covid?
steroid
217
Does ibuprofen help with covid?
no- may increase severity and duration
218
How can we boost immune system with common cold?
```
Rest
limit alcohol
better nutrition
stress management
physician emapthy
```
219
questionable tx of common cold?
isotonic nasal saline/Neti Pot and steam inhalation
220
sxs management co common cols?
```
honey
increase fluids
probiotic
intranasal ipratroprium
menthanol rub
increase of pillows
Zinc lozenges
Nsaids
inhalers
```
221
level of recommendation:
Patients 40 to 70 years of age who are overweight or obese should be screened for type 2 diabetes. Persons with abnormal results should be referred for intensive behavioral counseling interventions that focus on physical activity and a healthy diet.
B
222
what does metformin do?
Decreases hepatic glucose output
| • First line med at diagnosis of type 2
223
SE of metformin
nausea, bloating, diarrhea, B12 deficiency. To minimize GI Side effects, use XR and take w/ meals.
224
Sulfonylureas like glyburide, glipizide MOA
Stimulates sustained insulin release
225
SE of Sulfonylureas
Side effects: hypoglycemia and weight gain. Eliminated via kidney.
226
SGLT2 inhibitors (end in flozin) MOA
Decreases glucose reabsorption in kidneys
227
SE of SGLT2
Side effects: hypotension, UTIs, increased urination, genital infections, ketoacidosis.
228
DPP-4 inhibitors (end in gliptin) MOA
“Incretin Enhancers” • Prolongs action of gut hormones• Increases insulin secretion• Delays gastric emptying
229
SE of DPP-4 inhibitors
Side effects: headache and flu-like symptoms. Can cause severe, disabling joint pain. Contact MD, stop med.
230
DM rule of 3
1. microvascular
2. blood sugar control
3. Macrovascular complications
231
Microvascular complications what to check?-- rule of three
1. EYES (Retinopathy)--Annual visit with Ophthalmologist
2. KIDNEYS (Nephropathy)--Annual screen for Microalbuminuria
ACE-Inhibitor for HTN, Microalbuminuria
Follow Renal Function (Creatinine)
3. FEET (Neuropathy)--Patient Education: Foot Care
Inspect Patient’s Feet
Podiatry as needed
232
Blood sugar control- rule of three
1. HEMOGLOBIN A1C--Check every 3-6 months
Goal is less than 8
Avoid being over-aggressive w/hypoglycemic agents
2. LIFESTYLE--Nutrition
Activity
3. MEDICATIONS- Metformin First-Line
A variety of oral and injectable agents
Insulin
233
Macro-Vascular Complications-- rule of three
1. HYPERTENSION--Systolic BP <140
Consider lower thresholds if increased CV risk
Diastolic BP <90
2. LIPIDS--Follow 2013 AHA/ACC Guideline
Emphasize level of risk instead of LDL
Engage in shared decision making with the patient
3. CAD/CVA Prevention--Smoking Cessation, Nutrition, Activity
Stress ↓: Yoga, Meditation, Therapy
Consider aspirin if increased CV risk
234
An effective approach to office-based treatment includes a coherent framework for identifying and managing substance use disorders and specific strategies to promote behavior change. Brief validated screening tools allow rapid and efficient identification of problematic drug use, including prescription medication misuse. After a positive screening, a brief assessment should be performed to stratify patients into three categories:
1. hazardous use,
2. substance abuse,
3. or substance dependence
235
Patients with hazardous use benefit from
brief counseling by a physician.
236
For patients with substance abuse, brief counseling is also indicated, with the addition of
more intensive ongoing follow-up and reevaluation
237
true or false:
In patients with substance dependence, best practices include a combination of counseling, referral to specialty treatment, and pharmacotherapy (e.g., drug tapering, naltrexone, buprenorphine, methadone).
true
238
level of recommendation:
Patients with hazardous substance use or substance use disorders may benefit from brief counseling by their primary care physician.
B
239
level of recommendation:
| Office-based pharmacotherapy for opioid dependence using buprenorphine is safe and effective.
A
240
level of reccoemndation :
| Patients with substance use disorders may benefit from identification and treatment of comorbid psychiatric disorders.
A
241
BuprenorphineMOA
partial agonist of mu opioid receptors.
242
why is buprenorphine/naloxone is the preferred formulation?
he naloxone component is poorly absorbed via the sublingual route and is present only to prevent misuse of the medication by crushing and injecting the combined product.
243
Naltrexone MOA
antagonist of mu opioid receptors and can block the effects of opioid agonists
244
which of the pharm. to help w. opioid use disorder is associated with hepatic injury at supratherapeutic doses; therefore, liver function tests at baseline and every three to six months are recommended
Naltrexone
245
Depression screening
Sleep – increased or decreased (if decreased, often early morning awakening)
Interest – decreased
Guilt/worthlessness
Energy – decreased or fatigued
Concentration/difficulty making decisions
Appetite and/or weight increase or decrease
Psychomotor activity – increased or decreased
Suicidal ideation
Depressed mood most of the day, almost every day
246
level of recommendation:
Selective serotonin reuptake inhibitors are more likely than placebo to produce depression remission in the primary care population.
B
247
level of recommendation:
Serotonin-norepinephrine reuptake inhibitors are slightly more likely than selective serotonin reuptake inhibitors to improve depression symptoms, but they are associated with higher rates of adverse effects such as nausea and vomiting.
B
248
level of recommendation:
| Antidepressants are most effective in patients with severe depression.
A
249
true or false:
The benefit of antidepressants over placebo is more pronounced in patients with severe depression.
true
250
first line therapy for depression
Second-generation antidepressants are generally considered first-line therapy. Specific therapy choice should be based on cost, patient preference, and adverse effect profile.
251
Most common SE for discontinuation of a SSRI
N/V
252
The optimal treatment duration is unclear, but clinical guidelines suggest _________________ months for an initial episode of major depression. Patients with recurrent depression may benefit from prolonged treatment.
The optimal treatment duration is unclear, but clinical guidelines suggest four to 12 months for an initial episode of major depression. Patients with recurrent depression may benefit from prolonged treatment.
253
antidepressens in pregnancy?
High-quality evidence is lacking on the benefits and harms of antidepressant use in pregnancy. It is unclear whether selective serotonin reuptake inhibitor use in breastfeeding mothers causes adverse effects in their infants, but sertraline and paroxetine transfer to breast milk in lower concentrations than other antidepressants
254
level of recommendation:
| Exercise therapy should be prescribed for patients with fatigue, regardless of etiology.
A
255
level of recommendation:
Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft), may be helpful for patients with fatigue in whom depression is suspected.
B
256
level of recommendation:
| Cognitive behavior therapy is an effective treatment for adult outpatients with chronic fatigue syndrome.
A
257
level of recommendation:
| Stimulants seldom return patients to predisease performance.
B
258
level of recommendation:
| All women of childbearing age should be screened for IPV. There is a low risk of negative effects from screening.
A
259
JNC 8 Summary (January 2014)
- Goal _________ for <60 yo
- Goal _______ for 60 yo and older (______ for people who have a history of stroke or TIA and consider also for high ASCVD risk score, according to AFP, ACP - 2017)
- first line?
- DM2 and Chronic Kidney Disease (CKD) Goal is ___________ for all ages
- first line Medications? Second-line?
- What two medications we cannot use together
JNC 8 Summary (January 2014)
- Goal <140/90 for <60 yo
- Goal <150/90 for 60 yo and older (<140/90 for people who have a history of stroke or TIA and consider also for high ASCVD risk score, according to AFP, ACP - 2017)
- Lifestyle Modification still first line
- DM2 and Chronic Kidney Disease (CKD) Goal is < 140/90 for all ages
- Thiazides, CCBs, and ACEis (ARB if cough) are first line
- Beta-blockers considered second line
- Do not use ACEi and ARB together
260
JNC-8 vs AHA/ACC
Why do Fam med prefer JNC-8?
Disproportionate weight to the SPRINT trial, an RCT assessing standard vs. strict blood pressure treatment goals
261
true or false?
The ACA/AHA and JNC-8 guidelines both recognize that lifestyle modifications (DASH diet, weight loss, exercise, smoking cessation) are first line and are paramount for reducing morbidity and mortality associated with elevated BP. These interventions do not carry any of the risks associated with medications.
true
262
List specific examples of trauma-informed language and behaviors that can be utilized during the physical examination.
Physical examination
Ask patients if there are any parts of the physical examination that they feel anxious about, and if there is anything you can do to help make the physical examination feel more comfortable
Ask the patient to shift his or her clothing out of the way instead of doing it yourself (e.g., lifting his or her own shirt for an abdominal examination)
Ask the patient for permission before conducting each section of physical examination (e.g., when moving from heart to lung examination)
263
Physicians should deliver confidential health services in situations involving 5
1. reproductive health,
2. sexuality,
3. gender identity and expression,
4. substance use, and
5. mental health to consenting adolescents.
264
true or false
Adolescent patients should be made aware that certain situations and circumstances create limitations on guaranteed confidentiality. For example, detailing billing statements and Explanation of Benefits notices may be furnished to a guarantor/parent from a third party. Further, information suggesting someone is in imminent danger, the suspicion or evidence of abuse, and the diagnosis of certain communicable diseases all must be reported to the proper authorities.
true
265
HEADSSS
```
Home
Education
Activities
Drugs
Sex
SI
safety
```
266
Contraception to use in breast cancer?
copper IUD
267
What to avoid in contraception for cervical cancer?
IUD
268
what contraception to avoid in endometrial cancer?
IUD
269
what contraception to avoid in migraines w/ aura
OCPs
270
what contraception to avoid in HTN >160/100 and/or w/ vascular disease
OCPs
271
What contraception to avoid w/ liver disease?
OCPs
272
what contraception to avoid in PID?
IUD
273
what contraception to avoid in <3 post-partum, not breastfeeding or breastfeeding
OCPs
274
What contraception to avoid inSTI
IUD
275
What contraception to avoid in after septic abortion?
IUD
276
what contraception to avoid if smoking
OCPs
277
what contraception to avoid in SLE?
OCPs
278
level of recommendation:
Combined estrogen/progestogen therapy, but not estrogen alone, increases the risk of breast cancer after three to five years of use.
B
279
level of recommendation:
Systemic estrogen, alone or in combination with a progestogen, is the most effective therapy for menopausal hot flashes, and is approved by the U.S. Food and Drug Administration for this indication.
A
280
level of recommendation:
There is no high-quality, consistent evidence that black cohosh, botanical products, omega-3 fatty acid supplements, or lifestyle modification alleviates hot flashes.
B
281
level of recommendation:
Effective nonhormonal therapies for genitourinary syndrome of menopause include vaginal moisturizers and oral ospemifene (Osphena).
B
282
After a median of 13 years of follow-up, women taking combined estrogen/progestogen therapy in the Women’s Health Initiative trial had a significantly increased risk of _______________ and ______________, and a reduction in_________________.
After a median of 13 years of follow-up, women taking combined estrogen/progestogen therapy in the Women’s Health Initiative trial had a significantly increased risk of breast cancer and venous thromboembolism, and a reduction in hip fractures.
283
n the past, physicians prescribed hormone therapy to improve overall health and prevent cardiac disease, as well as for symptoms of menopause. Combined estrogen/progestogen therapy, but not estrogen alone, increases the risk of __________________ when used for more than three to five years. Therefore, in women with a uterus, it is recommended that physicians prescribe ______________ therapy only to treat menopausal symptoms such as vasomotor symptoms (hot flashes) and vaginal atrophy, using the smallest effective dosage for the shortest possible duration.
n the past, physicians prescribed hormone therapy to improve overall health and prevent cardiac disease, as well as for symptoms of menopause. Combined estrogen/progestogen therapy, but not estrogen alone, increases the risk of breast cancer when used for more than three to five years. Therefore, in women with a uterus, it is recommended that physicians prescribe combination therapy only to treat menopausal symptoms such as vasomotor symptoms (hot flashes) and vaginal atrophy, using the smallest effective dosage for the shortest possible duration.
284
Although estrogen is the most effective treatment for hot flashes, nonhormonal alternatives such as ____, ____, and ______ are effective alternatives.
Women with a uterus who are using estrogen should also take a progestogen to reduce the risk of _______________cancer.
Although estrogen is the most effective treatment for hot flashes, nonhormonal alternatives such as low-dose paroxetine, venlafaxine, and gabapentin are effective alternatives.
Women with a uterus who are using estrogen should also take a progestogen to reduce the risk of endometrial cancer.
285
One systematic review suggests modest improvement in hot flashes and vaginal dryness with __________ products, and small studies suggest that clinical hypnosis significantly reduces hot flashes.
One systematic review suggests modest improvement in hot flashes and vaginal dryness with soy products, and small studies suggest that clinical hypnosis significantly reduces hot flashes.
286
Patients with genitourinary syndrome of menopause may benefit from ______ ____________, or _____(the only nonhormonal treatment approved by the U.S. Food and Drug Administration for dyspareunia due to menopausal atrophy).
The decision to use hormone therapy depends on clinical presentation, a thorough evaluation of the risks and benefits, and an informed discussion with the patient.
Patients with genitourinary syndrome of menopause may benefit from vaginal estrogen, nonhormonal vaginal moisturizers, or ospemifene (the only nonhormonal treatment approved by the U.S. Food and Drug Administration for dyspareunia due to menopausal atrophy).
The decision to use hormone therapy depends on clinical presentation, a thorough evaluation of the risks and benefits, and an informed discussion with the patient.
287
SOCIAL GRADIENT OF HEALTH
Life expectancy is shorter and disease is more common further down the social / socioeconomic ladder
288
WHAT ARE SOME EXAMPLES OF SOCIAL DETERMINANTS OF HEALTH?
Education, employment opportunities, water, sanitation, housing, food access, level of social inclusion / exclusion, social support networks, stress, early childhood development, race/gender/sexual orientation/etc (as they impact the other SDHs)
289
WHAT IS THE RELATIVE IMPACT OF SDH ON HEALTH VARIANCE / OUTCOMES?
A lot; probably more than half
290
level of evidence :
Not all transgender or gender-diverse persons require or seek
hormone therapy. However, those who receive treatment generally
report improved quality of life, self-esteem, and anxiety.
B
291
level of recommendation:
| All adolescents and adults 15 to 65 years of age should be screened for HIV unless they explicitly refuse.
A
292
level of recommendation:
| All persons at high risk younger than 15 years and older than 65 years should be screened for HIV.
A
293
level of recommendation:
| All pregnant women should be screened for HIV during each pregnancy.
A
294
level of recommendation:
Preexposure prophylaxis should be provided to men and women (except those who are breastfeeding) who are at highest risk of HIV infection (e.g., men who have sex with men, those with an HIV-positive sex partner).
A
295
level of recommendation:
| It is recommended that combination antiretroviral therapy be initiated early to prevent HIV transmission.
A
296
The U.S. Food and Drug Administration approved the OraQuick In-Home HIV Test; however, there are concerns about reduced __________, possible misinterpretation of results, potential for less effective counseling, and possible cost barriers
The U.S. Food and Drug Administration approved the OraQuick In-Home HIV Test; however, there are concerns about reduced sensitivity, possible misinterpretation of results, potential for less effective counseling, and possible cost barriers
297
________________________ is the combination of safer sex practices and continuous primary care prevention services, plus combination antiretroviral therapy.
Preexposure prophylaxis (effective in select high-risk adult populations) is the combination of safer sex practices and continuous primary care prevention services, plus combination antiretroviral therapy. C
298
Evidence has increased supporting combination antiretroviral therapy for treatment at any _______________count.
Evidence has increased supporting combination antiretroviral therapy for treatment at any CD4 cell count.
299
level of recommendation:
| Combination ART should be initiated early to delay progression of HIV infection.
A
300
level of recommendation:
| Combination ART can prevent HIV transmission.
A
301
true or false?
Opportunistic infections are now less common than in the past because ART usually prevents or markedly delays progression to advanced HIV disease
true
302
Difference between PrEP?
Truvada vs Descovy
Truvada®external icon is for all people at risk through sex or injection drug use.
Descovy®external icon is for people at risk through sex, except for people assigned female at birth who are at risk of getting HIV from vaginal sex.
303
is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spirit manifestations. This is reflected in the individual pursuing reward and/or relief by substance abuse and other behaviors.
Addiction
304
Opioids vs Opiates
although often used interchangeably, opiates is officially a more restrictive term, referring only those compounds derived from the natural poppy (morphine, codeine, heroin). Opioids include those opiates, in addition to the semi-synthetic and the synthetic compounds.
305
means that there is a physiologic requirement for the substance. A lack of this substance induces withdrawal.
dependence
306
means that increasing doses of a medication are needed to achieve the same effect.
tolerance
307
is use of a substance out of socio-culturally accepted norms. There is no accepted use of heroin, so it is always an abuse. Alcohol, on the other hand, can either be used or abused.
Abuse
308
loss of control, continued use despite negative consequences, compulsion to use.
Addiction
309
for addiction treatment, can only be given in methadone clinics (inpatient stay also if approved by clinic), daily dose, random testing, no ceiling, commonly measured in UDS, large pain control potential.
Methadone
310
can be prescribed by any certified physician (8 hour training course), can be prescribed monthly, needs specialized urine test, blocks all other opioids, medium pain control, has ceiling, little or no euphoria, risk of respiratory depression only if taken with alcohol, benzodiazepine, or sedatives.
Buprenorphine
311
level of recommendation:
| Patients with opioid use disorder should be offered maintenance treatment with pharmacotherapy.
A
312
level of medicine:
Pharmacotherapy for opioid use disorder should be continued for as long as it helps the patient; patients should not be required to discontinue according to preset timelines
A
313
level of recommendation:
Participation in behavior therapies may be helpful for some patients with opioid use disorder, but studies are equivo-cal; it should not be a prerequisite for buprenorphine treatment
B
314
true or false?
| naltrexone can be used to opioid use and craving
ture
315
level of recommendation:
| Patients with substance use disorders may benefit from identification and treatment of comorbid psychiatric disorders.
A
316
level of recommendation:
| Office-based pharmacotherapy for opioid dependence using buprenorphine is safe and effective.
A
317
level of recommendation:
Patients with hazardous substance use or substance use disorders may benefit from brief counseling by their primary care physician.
B
318
Name changes to US healthcare as a result of the COVID19 pandemic that may improve primary care
1. Rethinking HIPAA
2. Investing In Primary Care
3. Promoting Continuity Of Care
4. A Research Agenda
319
Describe factors that contribute to the high cost of US healthcare
1. Americans use some expensive technologies, such as MRIs, and specialized procedures, such as hip replacements, more often than our peers.
2. The U.S. has the highest chronic disease burden and an obesity rate that is two times higher than the OECD average.
3. Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths.
320
level of recommendation:
| Pregnant women with iron deficiency anemia should be offered treatment.
B
321
level of recommendation:
| Folic acid supplementation should be recommended before conception.
A
322
level of recommendation:
| Pregnant women should be screened for asymptomatic bacteriuria between 11 and 16 weeks' gestation.
A
323
level of recommendation:
| Women at risk of preterm birth should be offered intramuscular (preferred) or vaginal progesterone.
A
324
level of recommendation:
| Breastfeeding should be recommended to pregnant women as the best feeding method for most infants.
A
325
level of recommendation:
| Counting fetal movement should not be recommended to pregnant women.
B
326
level of recommendation:
Pregnant women should be screened for tobacco use, and individualized, pregnancy-tailored counseling should be offered to smokers.
A
327
Testing for group B streptococcus should be performed between __________ weeks' gestation.
Testing for group B streptococcus should be performed between 35 and 37 weeks' gestation.
328
Screening for diabetes should be offered to all pregnant women between _________ weeks' gestation
Screening for diabetes should be offered to all pregnant women between 24 and 28 weeks' gestation
329
Women at risk of preeclampsia should be offered low-dose _____________ prophylaxis, as well as _________________________ if dietary calcium intake is low
Women at risk of preeclampsia should be offered low-dose aspirin prophylaxis, as well as calcium supplementation if dietary calcium intake is low
