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Flashcards in FAMily Med SG9 Deck (46)
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1
Q

How do you use progesterone levels to tell whether the pregnancy is viable?

A

Less than 5 is an evolving miscarriage. Over 25 is sustainable intrauterine pregancy. But algorithms using progesterone measurements have been assoc with a higher use of sugical management and missed ectopics (since 85% of ectopics will have a normal progesterone

2
Q

How can you use ultrasound to predict EDD throughout the trimesters?

A

In the first trimester, the crown-rump length is measured and the accuracy is within 1 week. If the EGA based on the ultrasound is greater than 1 week, you go by the ultrasound. In the second trimester, you do way more than 1 crown-rump measurement; you take a total of 4 measurements. These include biparietal diameter, head circumference, abdominal circumference, and femur length. In the second trimester, the accuracy is +/- 2 weeks and the same rules apply as in the first trimester. In the third trimester, the accuracy is pus or minus 3 weeks and you do not change the EGA

3
Q

How to manage an inevitable abortion?

A

You have 3 options- expectant management (but can take months), surgical managemen (D and C or vacuum), or medical management (vaginal misoprostol, then repeat on day 3)

4
Q

What is the time to completion for medical management of inevitable abortion

A

3-4 days; and the success rate is 95%

5
Q

Most frequent causes of death for a 55 yo M

A

Malignancy, heart disease, accident, DM, chronic lung disease, chronic liver disease, and cirrhosis

6
Q

Minor risk factors for CVD (those used for calculating the ASCVD)

A

Sedentary lifestyle, stress, premture family hx, excess alcohol use, obesity, poor diet, low selenium, and high homocysteine

7
Q

What is a MAJOR risk factor for CVD?

A

Current smoking

8
Q

What are the guidelines in terms of assessing the risk of your patients for CVD?

A

Assess major risk factos every 4 to 6 years in adults 20-79 who are free from atherosclerotic cardiovascular disease

9
Q

How effective are oral meds (like buproprion or varenicline) in helping smokers quit?

A

They increase the quit rate at 12 mos by twice. However, the quit rate is only like 2%, so they increase it to 4%

10
Q

What interventions have been proven to increase quit rates?

A

Group setting, oral meds, one-on-one counseling in combo with med, providing problem solving skills, assistacne, with social supports, and use of relaxation breathing techniques

11
Q

CAGE questinairre for drinkers

A

Felt the need to cut down, felt annoyed by criticism of your drinking, had guilty feeling about drinking, morning eye opener

12
Q

Waist circumference and waist-hip ratio are independent risk factors for what?

A

obesity

13
Q

Definition of metabolic syndrome

A

Any 3 of the following 5: fasting glucose over 100, BP over 130/85, triglycerides over 150, HDL less than 40 for men or less than 50 for womne, abdominal obesity (waist circumference over 40 for men or over 35 for women)

14
Q

Corneal arcus

A

Physical exam finding associated with dyslipidemia

15
Q

Melanoma ABCDE

A

Assymetry, borders irreg, color heterogenous, diameter over 6 mm, evolution over time

16
Q

When do you get the zoster vaccine?

A

Age 60

17
Q

Lung cancer screening

A

Pts 55-80 with 30 pack years who currently smoke or smoked in the last 15 years

18
Q

Hep C screening

A

One time screen for adults born between 1945 and 1965

19
Q

Screening questions for depression

A

Over the past 2 weeks, have you felt down, depressed, or hopeless? Over the past 2 weeks, have you felt little pleasure in doing things?

20
Q

Options for colon cancer screening

A

Colonoscopy every 10 years; Annual testing of 3 stools for blood plus flex sig every 5 years; Double contrast enema every 5 years; Virtual colonoscopy is considered experimental

21
Q

Lipid screening guidelines

A

Every 5 years, a lipid panel should be done. Treat with statins all patients over 20 yo with LDL over 190

22
Q

ECG changes that suggest existing coronary disease

A

ST depression or downsloaping ST suggests ischemia; ST elev is MI; Q waves suggest infarction

23
Q

U waves on ECG

A

Very nonspecific. Can be associated with bradycardia, hypokalemia, hypercalcema, or hypomagnesemia

24
Q

USDHandHS recommendations for exercise

A

Men participate in at least 150 min of moderate intensity aerobic exercise per week as well as muscle strengthening at least twice a week

25
Q

Recommendation for AAA screening

A

This is a B level recommendation. A one time abdominal ultrasound of the aorta in males 65-75 who have smoked

26
Q

Diet recs to lower heart disease

A

Fish twice a week. Oils in tofu, soy, canola, walnuts, flaxseed. Studies show that Vit C, E, and folic acid do NOT reduce the risk of MI or stroke

27
Q

What are the top 4 causes of mortality in the US

A

Top is smoking. Next obesity, then DM, then hypertension

28
Q

Cancers that are increased by obesity

A

Endometrial, breast, colon

29
Q

Wagner ulcer grading system for diabetic ulcers- stages 1 through 5

A

Stage 1 involves full skin but no underlying tissue damage; Stage 2 is down to ligaments and muscle but no bone; Stage 3 is deep cellulitis or abscess, often with osteomyelitis; Stage 4 is localized gangrene; Stage 5 is extensive gangrene that involves the whole foot

30
Q

Management of ulcers by grade

A

Grade 1 and 2- outpatient management with extensive debridement and treatment for infection if needed. Grade 3- evaluate for osteomyelitis and peripheral arterial disease and may require hospitalization. Grade 4 and 5 are emergent hospitalization and surgical consult for possible amputation

31
Q

Homan’s sign

A

Classic sign of DVT. Pain on passive dorsiflexion of the foot

32
Q

Risk factors for DVT besides the obvious

A

hypertension, hyperlipidemia, CHF, hyperhomocysteinemia, disease that increases blood viscosity (like polycythemia vera, sickle cell disease, and multiple myeloma)

33
Q

Diagnosing peripheral arterial disease

A

ABI less than 0.9

34
Q

What is the greatest modifiable risk factor for peripheral arterial diseaes?

A

Smoking

35
Q

Other risk factors for peripheral arterial disease besides the obvious

A

Chronic renal insufficiency, elevated CRP, hyperhomocystenemia

36
Q

Well’s criteria for diagnosis fo DVT

A

Get 1 point for: Active cancer, paralysis/paresthesias/recent plaster immobilization of the legs, bedridden/major surgery, localized tenderness along distribution of deep vein, entire leg swollen, calf swelling greater than 3cm than asymptomatic leg, pitting edema, collateral superficial veins. Subtract 2 points if alternative diagnosis as or more likely than DVT. If 3 points- high likelihood of DVT. If 1-2 pts, moderate chance. Less than that, low

37
Q

Criteria to treat DVT as an outpatient

A

Hemodynamically stable, good kidney function, low risk for bleed, stable and supportive home environment, daily access to INR monitoring

38
Q

Summary about LMWH versus unfractionated heparin

A

LMWH can be administred fewer times per day, lab monitoring not required, less likely to cause thrombocytopenia, and may be used outpatient. For unfractionated, it is titrated based on the aPTT and requires hospitalization because it is IV

39
Q

Treatment duration of Warfarin based on the event

A

For isolated calf thrombophlebitis, you can do 6-12 weeks; For first time provoked event, do 3 mos; for first time unprovoked event, do 6 mos; for recurrent event (provoked or not) or inherited thrombophilia, do 12 mos to lifetime

40
Q

How long does it take Warfarin to reach stable state?

A

5-7 days, because the half life is 40 hours

41
Q

Checking INR after you have started someone on warfarin

A

If INR is between 5 and 9, discontinue the Warfarin and repeat INR in 24 hours. If INR is greater than 9, hold the warfarin and give PO vitamin K

42
Q

When to screen for inherited thrombophilias

A

Initial thrombosis prior to age 50 without obvious provoking event; family hx of venous thromboembolism; recurrent venous thromboembolism; thrombosis occuring in unusual vascular beds such as portal, hepatic, mesenteric, or cerebral veins

43
Q

Five MAJOR risk factors for coronary heart disease

A

In addition to elevated LDL, these are smoking, hypertension, HDL less than 40, family history of premature CHD in a male relative less than 55 or female less than 65, age in men over 45 or women over 55

44
Q

Medical conditions that cause dyslipidemia

A

Type 2 DM (or insulin resistance); cholestatic or obstructive liver disease; nephrotic syndrome; hypothyroidism; acute hepatitis; alcohol is a secondary cause; meds

45
Q

Meds that cause dyslipidemia

A

Thiazide diuretics, beta blockers, oral estrogens, protease inhibitors

46
Q

Metabolic syndrome is associated with a higher risk of what disease?

A

CHD, CM, hepatic steatosis, HCC (maybe as a result of hepatic steatosis), cholangiocarcinoma, CKF, OSA, hyperuricemia/gout