Family Medicine 2 Flashcards
(207 cards)
1
Q
tf
valvular heart disease can cause palpitations
A
t
2
Q
tf
palpitations can be atypical presentation of CHD
A
t
coronary heart disease
3
Q
palpitations affecting sleep or work inc likelihood that they are caused by __
A
arrhythmia
4
Q
proportion of palpitations caused by
A
190 pt univ hops study
43% cardiac
31% anxiety/panic
6% prescription or recreational drug
another study found 19% no specific cause
5
Q
another name for menopause
A
climacteric
6
Q
climacteric means
A
menopause
vs critical
7
Q
some drugs that cause palpitations
A
caffeine alc tobac cocaine
sympathomimmetics, vasodilators, anticholinergics
BB withdrawal
8
Q
tf
Cushings presents with palpitations
A
f
it does not
9
Q
DSM-V for panic attack
A
abrupt surge in fear or discomfort w/in mins 4+ of palps sweats shakes sob chokes chest pain/discomfort nausea ab discomf dizzy chills/heats paresthesias derealization depersonalization fear of losing control / "going crazy" fear of dying
10
Q
DSM-V for panic disorder
A
recurrent panic attacks
1+ month of fear of attacks +/- maladaptation
not attributable to drug or another disease
11
Q
most common structural heart abnorm presenting w palpitations
and PE finding
A
MVP
mid-systolic click w murmur
12
Q
LVH
Q waves in I AVL V456 suggests
A
HOCM
13
Q
workup palpitation
A
ekg (dysrrhyth) 24-48hr holter monitor week-months loop recorder echo (structural) cbc (anemia) tsh (hyperthy) urine drug screen
14
Q
tf
LDL-c targets dictate statin therapy in 2016
A
f
15
Q
statin therapy targets what diseases to prevent
A
stroke
MI
16
Q
what pharmacologic agents are recommended for lowering cholesterol 2016
A
statins only
17
Q
4 indications for statin
A
ASCVD (stroke MI UA TIA PVD) -high intensity statin 40-75y w DM (also consider outside this age) -Mod intense high if ASCVD risk ^7.5% ^21 w LDL-c ^190 (often genetic) -high intensity 40-75y w ASCVD risk ^7.5% -mod or high
18
Q
high intensity statins
A
Atorvastatin 40-80mg
Rosuvastatin 20-40mg
19
Q
tf
count risk factors to select cholesterol mgmt plan
A
f
not anymore 2016
based on calculated ASCVD risk
20
Q
tf
angina presentation in women is more likely to be atypical
A
t
95% F MI report prodrome
only 30% report chest discomfort
21
Q
some characteristics of pain less likely angina
A
pleuritic - PE PNA pneumothorax pleurisy pleuropericarditis
pulsating
positional - pericarditis pleuritic msk
palpation reproduced - msk
22
Q
prodromal sx of ACS in F
A
fatigue dyspnea neck jaw pain palps cough n/v indigestion back pain dizzy numb
23
Q
Erikson’s stages of human dev
A
infant - trust / mistrust toddler - autonomy / shame doubt preschooler - initiative / guilt school age - industry / inferiority adolescent - identity / role confusion young adult - intimacy / isolation middle age - generatively / stagnation elderly - integrity / dispair
24
Q
sandwich generation
A
caring for children and elderly parents
25
tf
| normal keg rules out CAD
f
spec if not symptomatic at exam
may be anginal but not infarct
26
neuro dysreg from stress
noradrenergic
| serotonergic probably too
27
when to give baby asa for primary prevention of CAD
50-59y w 10%+ ASCVD risk
not bleed risk
10 year life expectancy
willing to take dose for at least 10 years
28
exercise recommendation for adult
moderate-vigorous 3-4x/wk 40min
29
when is age a risk factor for CAD
45+ men
| 55+ women
30
when is FH a risk factor for CAD
1st deg relative w CHD
male v55
femal v65
31
35 yo women in good health should be screened for
htn
not CBC TSH CHO HBA1C at this age healthy
32
tf
| asa dec risk of ischemic stroke in men
f
| ASA prev MI in men, ischemic stroke in women
33
how long does it take for most low back pain to resolve
2-4 weeks
34
low back pain ranks __ for volume of outpatient visits
5th
35
broad differential for low back pain
CT MIIND VV
congenital - scholi kypho spondy
traumatic - strain compress fx
metabolic - OP hyperthy peget osteomalac
infectious - osteomy pyelo discitis herpzos abscess
inflammatory - ank spond sacroiliitis RA
neoplastic - MM mets lymphom leuke osteosarc
degenerative - disc hern OA facet arth spin stenos
vascular - aortic aneur diabetic neurop
visceral - prostatit PID ov cys endometrios kid ston cholecystit pancreatit
36
3 most common causes of low back pain
lumbar strain
disc hern
degenerative joint dz
(all mechanical (97%))
vs far fewer visceral or non-mechanical
37
tf
| kidney stones and pyelo are common causes of low back pain
f
most commonly mechanical (strain, disc hern, degen joint)
not visceral
38
red flags for serious low back pain (illness vs neuro compromise)
```
fever
weight loss
pain at night
bowel bladder incont
neuro sx
```
39
valsalva can increase low back pain caused by...
herniated disc
40
low back pain improved in supine position suggests
spinal stenosis
| disc herniation
41
cauda equina syndrome
```
always consider in low back pain because perm neuro def possible
large mass effect (disc hern, tumor)
compress cauda equina
pain/numbess radiate down leg
bowblad incont (low on ddx without)
```
emergent decompression within 72 hours
42
low back pain from mets inc or dec w recumbency?
inc w recumbency
| and cough
43
ank spondy location
spine and sacroiliiac
44
most common causes of referred lumbar pain men vs women
prostatitis
| PID endometriosis
45
order of position for back exam
standing
sitting
supine
46
standing back exam
inspect curvature
check flexion 90, extension 15, side hand to fib
palpate paraspinals
walk heel (L5 disc hern) toe (S1 disc hern)
squat (relieves spinal stenosis)
47
heel walk is difficult with what cause of low back pain
L5 disc hern
48
toe walk is difficult with what cause of low back pain
S1 disk hern
49
squatting relieves back pain assoc w
spinal stenosis
50
side-bend low back pain on same vs opposite side of bend suggests
same side - bone oa or neural compression
| op side - muscle strain
51
low back pain w flexion suggest
herniation
oa
muscle spasm
52
low back pain w extension suggest
degen dz
| spinal sten
53
seated back exam
```
CVA tenderness
leg raise
tripod sign
reflexes
motor
sensory
```
54
grade deep tendon reflexes
```
0 none
1+ hyporeflexic
2+ normal
3+ hyperreflexic
4+ clonus repeat shortening w one stim
```
55
nerves of patellar reflex
L3 L4
56
nerves of achilles reflex
L5 S1
57
grade muscle strength
```
0/5 none
1 flicker not movement
2 movement not antigravity
3 antigravity not resistance
4 overcome some resistance
5/5 normal strength
```
58
spinal nerves of hip flexion
L234
59
spinal nerves of hip abduction
L45 S1
60
spinal nerves of hip adduction
L234
61
spinal nerves of knee extension
L234
62
spinal nerves of knee flexion
L5 S12
63
spinal nerves of ankle dorsiflexion
L45
64
spinal nerves of ankle plantar flexion
S12
65
```
spinal nerves of
hip flexion
hip adduction
knee extension
ankle dorsiflexion
hip abduction
knee flexion
ankle plantarflexion
```
```
hip flexion L234
hip adduction L234
knee extension L234
ankle dorsiflexion L34
hip abduction L45 S1
knee flexion L5 S12
ankle plantar flexion S12
```
66
spinal nerve of
great toe sensation
lateral malleolus
posteriolateral foot
great toe sensation L5
lateral malleolus S1
posteriolateral foot S1
67
supine back exam
```
auscultate bruit AAA
palpate ab/pelv tenderness
rectal exam ONLY in red flags
-masses bleeding (mets) abnorm tone (disc hern cauda equina)
passive SLR
FABER
pelvic compression
```
68
specify tight hamstrings on SLR
can't SLR to 80 deg
lower slightly, dorsiflex foot - no pain = hamstrings tight
(nerve pain if radiating pain - L5 S1 espec)
69
pain v30deg on SLR suggests
malingering
70
pain opposite of SLR suggests
root compression from central disc hern
71
SLR sn sp compared to MRI
36% sn
| 74% sp
72
what is "crossed leg raise" pe maneuver
SLR of asymptomatic leg
+ suggests central disc hern
(not sn 25% but highly sp 90% so neg does not rule out but pos virtually diagnostic of disc hern)
73
FABER test
flexion abduction external rotation
(pressure on flexed knee while stabilizing op hip)
hip or si path
74
pelvic compression test
forcibly press hips together
| + causes si pain
75
disc hern pain
exacerbated w
relieved w
inc w sitting or bending
coughing sneezing
dec w lying or standing
76
tf
| disc hern can cause foot drop
t
| muscle weakeness
77
tf
| urinary retention assoc w disc hern
f
| cauda equina syndrome
78
pretty comprehensive red flags for low back pain
```
hx ca
ue wl ^10kg 6 mos
^50 v17 age
persists more than 4-6 wks
night pain rest pain
persistent fever (100.4)
IVDU
UTI PNA cellulitis recently
immunocompromise (DM steroids HIV)
U incont or retent
saddle anesth
anal tone dec fecal incont
bilat le weak numb
progressive FNDs
3/5 muscle weakeness (antigrav not resist)
foot drop
prolongued corticosteroids
mild trauma 50y+, major trauma any age
70y+
OP
prev vert fx
```
79
cauda equina syndrome red flags
```
u incont renent
fecal incont dec anal tone
saddle anesth
bilat le numb weak
FNDs progressing
```
80
cancer low back pain red flags
```
hx ca
ue wl ^10kg 6 mos
^50 v17 age
persists more than 4-6 wks
night pain rest pain
```
81
infection low back pain red flags
```
persistent fever (100.4)
IVDU
UTI PNA cellulitis recently
immunocompromise (DM steroids HIV)
U incont or retent
```
82
disc hern low back pain red flags
major 3-/5 muscle weakness (not resisted)
| foot drop
83
vertebral fx low back pain red flags
```
prolonged corticosteroids
OP
mild trauma 50y+
major trauma any age
70y+
prev vertebral fx
```
84
when to get CBC for low back pain
tumor or infection suspected
| get ESR too
85
guidelines for low back pain xr
```
hx trauma
strenuous lifting w OP
prolongued corticosteroids
OP
v20y ^70
hx ca
fever chills wl
pain worse supine night
fx tumor infection suspected
```
86
MRI indications for low back pain
```
FND
radiculopathy... not if prob disc hern not progressing?
progressive major motor weakness 3-/5
bowel/bladder cauda equina
suspect mets or infection systemic
failed 6 wks conservative care
```
87
% hern discs improve w/in 6 wks conservative
75%
88
tf
| early MRI assoc w improved outcomes ni pts w acute back pain or radiculopathy
f
89
how to id lumbar vertebra on xr
not rib bearing
90
approach to AP spine xr
```
count lumbar verts
-non-rib bearing, typically 5 but variable
2 eyes and nose per vert
-pedicles and spinous process
alignment
disc space uniformity
si joint margins
ab/pelv path - kid calcs, vasc calcs, foreign bodies
```
91
approach to lat spine xr
vert body height uniformity
disk space uniformity (diminish gradually down)
alignment
osteophytes
ab/pelv path - kid calcs, vasc calcs, foreign bodies
92
particular concern in spine xrs
for women ovarian radiation risk equivalent to daily CXR for one year
93
conservative therapy for low back pain
NSAIDs acetaminophen muscle relaxants
| moist heat
94
tf
| strict bed rest for low back pain
f
| encourage to resume normal activities as soon as able
95
tf
| physical therapy and spinal manipulation for low back pain
tish
some evidence
safe
but staying active (but avoiding strain) almost as effective
96
manage pt expectation for low back pain treated conservatively
most improve 2-6 wks
(90% resolved 1 mo only 5% persist 3 mo)
recurrence 35-75%
longer recovery time older you get (^45y)
out of work ^6mos only 50% return to work
........^2y ~0% return to work
97
reasonable mgmt options for
| low back pain radiculopathy from hern disc progressing slightly after 5 wk conservative mgmt
- refer to surgeon
- continue NSAIDs acetaminophen muscle relaxants moist heat activity not strenuous
- epidural steroid injection
98
lifetime prevalence of low back pain
60-80%
99
```
L3
reflex
sensation
motor
function
```
patellar tendon reflex
lateral thigh medial femoral condyle sensation
extend quads
squat/rise
100
```
L4
reflex
sensation
motor
function
```
patellar tendon reflex
medial leg and medial ankle sensation
dorsiflex ankle
heel walk
101
```
L5
reflex
sensation
motor
function
```
medial hamstring reflex
lateral leg dorsum foot sensation
dorsiflex great toe
heel walk
102
```
S1
reflex
sensation
motor
function
```
achilles reflex
post calf foot sole lat ankle sensation
plantarflex ankle
walk on toes
103
point tenderness on spinous process in context of low back pain suggests
vertebral origin
| OP fx, malignancy, etc
104
```
male low back pain
malaise chills hesitancy and pain with urination
fever
suggests..
what PE to corroborate
```
prostatitis
| DRE for tenderness over prostate
105
negatively birefringent rods aspirated from joint in
gout
106
positively birefringent rhomboids aspirated from joint in
pseudogout
107
baker's cyst aka
popliteal cyst
108
knee exam
palpate locations
for
```
patella
quad tendon
patellar tendon
tib tubercle
joint line all around
```
109
normal knee rom
135 degrees
110
lachman vs ant drawer sign
| which tests acl?
both
111
mcmurray test
for meniscal tears (though sn sp questionable)
| apply rotation and var/valgus stress while extending knee for pain clunking clicking
112
3 top ddx for peds w knee pain
```
patellar sublux
tibial apophysitis (osgood schlatter)
patellar tendonitis
```
113
tf
| psoriatic plaques must be present to dx psoriatic arthritis
t
| BUT in ~15% cases arthritis appears first so can keep on ddx
114
define oligoarthritis
2-4 joints
| 5+ = polyarthritis
115
synovial wbc in
septic arthritis
vs
gout pseudogout
15k - 200k
vs
3k - 50k
116
popliteal baker cysts often arise in association with
underlying disease such as ra oa
117
ankylosing spondylitis
genotype assoc
joints affected
HLA-B27
| lumbar spine, si, hips sometimes
118
accompanying sx to look for in suspected SLE arthritis
```
fev
rash
raynaud
pleuritis
chest pain
```
119
to look for in suspected lyme arthritis
prior rash, fever, migratory arthralgia
120
workup of suspected
septic arthritis or
acute inflammatory arthropathy
cbc w diff
ESR
arthrocentesis w cell count diff glue protein cx sns
...polarized light microscopy for crystals
121
ddx arthrocentesis
transudative
hemarthrosis
hemarthrosis w fat globules
transudative - oa degenerative miniscal inj
hemarthrosis - lig ten tear fx
hemarthrosis w fat globules - osteochondral fx
122
ottowa knee rules
```
xr any of
55y+
isolated patellar tenderness
fibular head tenderness
can't flex 90
can't bear weight immed or ed (4 steps limp ok)
```
123
when to consider knee MRI
locking popping instability
(cartilage miniscal ligament damage)
but if xr and hx clear oa w js narrowing... can opt out of MRI
124
% US w dxd arthritis
22%
125
tf
| exercise improves function and dec pain in OA
t
126
paracetamol generic
acetaminophen
| aka tylenol in the UK
127
best 1st choice for short-term mild-mod oa pain
acetaminophen
(tylenol, paracetamol in UK)
toleratbility, low se profile (hepatotox rare if taken approp -- 4gm max/day)
128
intraarticular corticosteroid inj
```
for inflamed joint (swelling pain)
1/mo max, 3/yr max
long-acting triamcinolone preferred to methylprednisolone
combo 1ml w 3-4ml local anesthetic
rest 24 hr not more
fewer se than nsaids or opiates
```
129
toradol vs tramadol
```
toradol = ketorolac = nsaid
tramadol = opioid
```
130
acupuncture benefit arthritis?
maybe some
131
glucosamine
chondroiotin sulfate
benefit arthritis?
maybe some combined
132
tramadol for joint pain?
opioid
limited by se
modest benefit in older pts moderate-severe pain
133
NSAID cream for joint pain?
better than nothing
134
tf
| arthroscopic debridement improves OA pain and function
f
| not proven
135
phalen test
press dorsum of hands together 30-60 sec
136
atrophy of thenar eminence in...
long standing untreated carpal tunnel
137
how useful are tinel and phalen when testing for carpal tunnel
somewhat useful
lower sn
high sp
(so will not catch all ct, but if positive likely ct)
nerve conduction velocity study is dx test of choice
138
diagnostic test of choice for carpal tunnel
| when to get
nerve conduction velocity study
- expensive uncomfortable
- only do if sx fail conservative tx, motor dysfunction, thenar atrophy
139
PHQ-2
sn
sp
bothered feelling down dep hopeless
bothered little interest or pleasure
+1 = positive
sn 87% sp 78%
f/u w PHQ-9 or other to dx and severity
140
most common se of long acting opioids
constipation
| tx w bowel reg lax softeners exercise water fiber
141
what assoc of TCAs makes them CI in pts w CV dz or nerve conduction problems
```
anticholinergic side effects
dry mouth
urinary reten
constipation
blurred vision
```
tachyarrhythmias bp changes heart block mi
142
long or short acting opioids higher risk of dependence
short acting
143
tf
| anticonvulstants for chronic pain syndromes
f
for trigeminal neuralgia
not other chronic pain evidence lacking
144
what to watch for carbamazepine in young woman
cyp p 450 inducer
| OCPs less effective
145
NSAID se's
acute
chronic
GI upset
dec effectiveness of antihtns
inc effect of sulfonylureas
GI ulcers
ESRD
hepatotox, coagulopathy
146
tramadol moa
use
se
centrally acting mu opioid analgesic
stim serotonin release
inhib ne reuptake
control mod severe pain
lower abuse potential than more potent opiods
but still abuse potential
seizures serotonin syndrome resp dep angioedema bronchospasm dependence
constipation nausea dizziness pruritus
147
age range for colorectal cancer screening
50-75
148
stop screening for colorectal cancer at
75
149
age range for screening mammography
50-74 biennially
150
AAA screen recs
men 65-75 smoking hx
151
AAA screening recs in women
none
| USPSTF recommend against
152
USPSTF carotid artery stenosis screening in asymptomatic pts
don't screen carotids in asymptomatic pts
153
lipid screening in women
45+ at inc risk for lipid CAD
154
routine thyroid screening?
insuffic ev for or against
155
when to stop cervical cancer screening
65
| if adequate screening negative prior
156
best confirmatory test for lyme after joint aspiration
synovial fluid PCR
| not cx, less sensitive for lyme
157
tf
| caution w nsaid use pt on warfarin
t
| nsaids can inc effect of anticoagulants
158
tf
| caution w nsaid use pt hx h.pylori infection
f
| not a CI
159
pt w gout has ci to said and colchicine
| next question to guide tx?
number joints involved
1-2 jionts arthrocentesis w intra-articular glucocort inj
polyarticular oral glucocorticoids
160
routine prenatal folic acid dose
400-800mcg
.4-.8mg
1mg DM or epilepsy
4mg prior child w neural tube defect
161
prenatal genetic screen
```
sickle cell
thalassemia
tay-sachs
cystic fibrosis
non syndromic hearing loss (connexin-26)
```
162
prenatal ID screen
HIV
syphilis
Hep B immunization
rubella varicella immunization
toxoplasmosis - avoid cat litter, garden soil, raw meat
CMV parvovirus B19 (fifth dz) - hand washing
163
environmental toxins to avoid prenatally
paint thinners pesticides
tobacco smoke
alcoholism drugs
164
medical adjustments prenatally
```
DM - control, folic acid 1mg, stop ACEI
HTN - avoid ACEI ARB thiazide dour
Epilepsy - control, folic acid 1mg
DVT - switch warfarin to heparin
Depression/Anxiety - avoid BZD
```
165
lifestyle mod prenatally
```
regular moderate exercise
avoid hot tubs hyperthermia
caution obesity underweight
screen domestic violence
assess nutritional risk
-- vegan pica milk intol ca fe deficiency
avoid Vit A overuse (2500 - 10000 IU)
avoid Vit D overuse(600 - 4000 IU)
limit caffeine 2 cups coffee
```
166
goodell's sign
softening of cervix in pregnancy
167
hegar's sign
softening of uterus in pregnancy
168
Chadwick's sign
purpling of cervix and vaginal walls in pregnancy
| -hyperemia
169
when is enlarged uterus first palpable by experienced examiner
8 wks gestation on bimanual exam
170
when is uterine funds palpable above pubis symphysis
12 wks gestation
171
when is uterine measurement used to approximate gestational age
20-36wks
172
quickening
fetal movement
| detected by mother 18-20wks gestation
173
when are fetal heart tones elicited
hand-held doppler 10-12 wks gestation
174
what is a medical abortion process like
two-step
first pill in office, not usually noticeable
second pill at home 2-3 days later, cramping and heavy bleeding within hours
f/u one week later
175
Naegele's Rule for calculating estimated due date
first day of LNMP
add 1 year
subtract 3 mos
add 1 wk
176
early in prey, which is higher, urine or serum hCG?
serum hCG
177
when to give RhoGAM (RhoD Immune Globulin)
RH- mother any bleeding episode during pregnancy, regardless of gestational age
178
ectropion
turned out
| eg eyelid or cervix
179
how many pregnant pts experience vaginal bleeding in first trimester
1/4
180
chance of miscarriage when significantly bleeding in first trimester
25-50%
181
tf
| most pregnant pts have mild leukocytosis
t
182
when is progesterone level useful to get in preg
ectopic v5
sustainable intrauterine preg ^25
between not too helpful
so extreme values useful
183
when is hCG secreted by trophoblastic cells
day 7 post ovulation
| early embryonic life
184
ddx higher than normal vs lower than normal hCG
higher mole multiple test
| lower ectopic spontaneous abortion
185
most definitive pregnancy diagnosis
hCG quant
| pelvic us
186
3 most common causes of bleeding early in preg
spontaneous abort
ectopic
idiopathic in viable pregnancy
187
cervical os dilated w obvious bleeding early in prey suggests
spontaneous abortion
188
distended acute abdomen w vaginal bleeding early in pregnancy suggests
ruptured ectopic
189
at what b-hCG level can US detect intrauterine pregnancy reliably?
b-hCG ^1500
190
patient becomes unstable w
unstable spontaneous abortion
ruptured ectopic
mgmt
unstable spont abort - d&c
ruptured ectopic - laparoscopy or laparotomy
191
gestational trophoblastic dz aka
molar pregnancy
| aka placenta acts like a tumor
192
change EGA or EDD based on LNMP if US findings differ?
1st and 2nd trimester, yes.
| 3rd trimester, fetal size cannot be used to accurately estimate, do not change due date.
193
accuracy of fetal US in predicting EDD
1st tri +/- 1wk
2nd tri +/- 2wk
3rd tri +/- 3 wk
194
define spontaneous abortion
loss of preg w/o outside intervention v20wk gestation
195
define threatened abortion
bleeding before 20wks gestation
196
define inevitable abortion
dilated cervical os....
| as compared to threatened abortion or missed abortion (no dilation)
197
define missed abortion
fetal demise w/o cervical dilation and/or uterine activity (often found incidentally on US w/o presentation of bleeding).
198
what to expect w expectant management of inevitable abortion
- watchful waiting w precautions regarding unusual amounts of bleeding or pain fever
- 75% effective
- can take up to 1mo for complete expulsion
- can delay emotional closure
- give RhoGam (rhesus immune globulin) for Rh-
199
mgmt options for inevitable abortion
-expectant: 75% effective, can take 2-6 wks
-surgical D&C vs vacuum for pt pref or heavy bleeding
CI pelvic infection
-medical: off-label vaginal misoprostol 95% effective 3-4 days to 2 wks
RhoGam always for Rh- in all cases!
200
some miscarriage stats
about 1/3 pregnancies end in miscarriage
1/2 of 1st tri miscarriages due to chromosomal abnorm
201
tf
| miscarriage indicates fertility problem
fish
not necessarily
many successful pregs after miscarriage
87% miscarriages have subseq normal births
202
tf
stress
physical activity
sex
can cause miscarriage
f
| no evidence supporting this
203
labs for initial preg eval
CBC RPR HIV Rub type/scren HepB
204
purpose of CBC in initial pregnancy eval
nutritional anemia
congenital anemia
plt disorders
205
tf
| CMP routine initial pregnancy eval
f
| only ordered as indicated
206
rate of b-hcg increase
doubles q48hr in first 6-7wks gestation if intrauterine preg
less if ectopic
207
how does b-hcg correspond to ability to detect preg on us?
transvag us detects intrauterine preg w b-hcg 1500-1800
transab w b-hcg ^5000
