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family medicine notes questions Flashcards

1
Q

name the bedside test used to determine if bleeding is maternal or fetal?

A

modified APT test

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2
Q

name three medications used to treat early PPH

A

oxytocin
ergotamine
hemobate

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2
Q

what are risk factors for retained products of conception following birth?

A

-prior C-section
-uterine infection
-manual placental removal
-placenta previa

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2
Q

what are SE of SSRIs for the baby in a breastfeeding mom ?

A

irritability, insomnia

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3
Q

when does the risk of fetal death from parvovirus decrease?

A

at 20 weeks gestation

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4
Q

consequenses of parvovirus 19 infection in pregnancy?

A

fetal loss, hydrops/anemia, high output cardiac failure in baby

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5
Q

first line therapy for post natal depression

A

CBT

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5
Q

what are the two tests to diagnosis PROM?

A

-ferning
-nitrazine blue

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6
Q

risks associated with untreated BV in pregnancy?

A

-post partum endometritis
-preterm birht
-low birth weight

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7
Q

risk factors for BV

A

-pregnancy
-new sex partner
-multiple sex partners
-douching
-IUD use

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8
Q

causes of pediatric vaginitis?

A

-non specific (irritants, tight clothing, thin mucosa)
-bacteria (e coli, H influenza)
-rarely candida
-foreign body
-systemic illness (chickenpox)
-poor hygeine
-pinworms
-sexual abuse/STI
-dermatologic (eczema, psoriasis, lichen sclerosis)

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9
Q

name 3 indications for hip US for ddhx?

A

-breech
-family hx
-abnormal exam finding

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10
Q

when do the posterior and anterior fontanelles close?

A

2 mo
18 mo

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11
Q

how do you switch from the patch to the OCP?

A

take the first pill one day before taking off the patch

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12
Q

how long can the nuva ring be outside of the vagina for ?

A

3 hours

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12
Q

name three shockable rhythms

A

VF
pVT
torsades de pointes

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12
Q

most common site for lung cancer metastasis?

A

liver

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13
Q

what do you advise pts to do during a hypoglycemic episode?

A

-take 15g glucose
-retest BG in 15 minutes
-repeat glucose load if it remains < 4

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14
Q

if both IFG and A1C are between 6 - 6.4, what is the risk of progression to T2M in 5 years?

A

100%

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14
Q

what are the criteria for screening for DM in adolescents/children:

A

PREPUBERTAL if 3/4 and PUBERTAL if 2/4 of:
-obesity
-s/s of insulin resistance such as acanthosis nigracans, NAFLD, hyperlipidemia
-1st degree relative with DM or utero exposure
-increased risk ethnic group

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15
Q

Which patients with prediabetes should consider metformin?

A

Age <60
Hx of GDM
BMI > 35

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16
Q

what factors may increase an A1C (impair accuaracy)

A

-iron deficiency, B12 deficiency, alcoholism, CKD, chronic opioid use

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17
Q

what factors may decrease an A1C (impair accuracy)

A

–iron/B23/vitC/E supplementation, asa use, hemoglobinopathy, chronic liver dz, CRF, RA, antiretrovirals , splenomegaly

18
Q

what DM medication should be avoided/cautioned with a history of severe alcohol abuse?

A

SGLT2i

19
Q

what is the A1C cutoff for diabetes?

A

≥6.5%

20
Q

what is the fasting blood glucose cutoff for diabetes?

A

≥7 mmol/L

21
Q

angina criteria (3)

A

-substernal chest discomfort: dull/ache/heaviness, that might or might not radiate to jaw, neck, shoulders or arms
-provoked by exertion or stressed
-relieved within 5 minutes by rest or nitroglycerin use

22
Q

exam findings consistent with ischemic heart disease

A

-Hypotension
-new S3 gallop
-new JVP distention
-pulmonary rales
-mitral regurgitation

23
Q

if someone is having an MI and there allergic to NSAIDS, do you give aspirin?

A

NO

23
Q

ECG findings suggestive of STEMI (list 2)

A

-new LBBB
-ST elevations - 2 contiguous leads of >0.1mV (>0.2mV in V2 V3

24
Q

what does a new Q wave suggest?

A

STEMI or NSTEMI

25
Q

name 5+ causes of elevated troponin?

A

HF, malignancy, pericarditis, sepsis, stroke, SAH, PE, myocarditis

26
Q

if someone is having an MI and can’t take aspirin what do you give them?

A

300 mg clopidegrel then 75mg OD

27
Q

which patients with hx ACS should be prescribed an ACEi?

A

STEMI in anterior location, DM, HTN, CKD, LVEF <40%
(but can consider in all patients who have had cardiac/vascular disease)

28
Q

A patient is having an NSTEMI. What are the indications for immediate invasive strategy?

A

-unstable vitals
-refractory angina
-HF
-sustained VT/VF

29
Q

what are the absolute contraindications for fibrinolysis?

A

intracranial hemorhage, cerebral lesion/malignancy, head/facial trauma < 3 mo, ischemic stroke <3 mo, active bleeding, aortic dissection, severe uncontrolled HTN

30
Q

within how many minutes should PCI be performed?

A

90

31
Q

within how many minutes should fibrinolysis be performed?

A

30

32
Q

what is the most common SECONDARY cause of HTN?

A

chronic renal insufficiency

33
Q

in which age group should beta blockers be avoided as a first line HTN management?

A

≥60

34
Q

what populations should beta blockers be avoided for management of HTN?

A

-raynauds, asthma, ≥60, heart block or sick sinus syndrome, severe PAD, uncompensated HF

35
Q

if someone has angioedema on an ACEi, what is the chance they have it with ARBs?

A

10% cross reactivity

36
Q

Management of pulmonary edema secondary to HTN emergency?

A

IV enalapril, nitroinfusion, sublingual captopril

37
Q

Management of ACEi angioedema?

A

-stop offending medication
-possible intubation / respiratory support
-epinephrine
-steroids/antihistamine for mild cases
-consider icatibant (bradykinin antagonist), FFP

38
Q

name 5 peices of advise for taking home blood pressure readings?

A

-appropriate cuff size (40% circumferance of arm and 80-100% length)
-measure in non dominant arm unless >10 mmhg difference
-relax for 5 minutes with back straight and feet on floor
-no coffee or smoking for 1 hr prior
-no exercise for 30 minutes prior
-take 2 before breakfast and 2 after dinner
-average day 2-7

39
Q

patients with afib over what AGE get OAC regardless of other factors?

A

65+

40
Q

what is considered a low reccurrence rate of paroxysmal afib?

A

1-2 episodes per year

41
Q

if someone has high reccurrence of paroxysmal afib what is the management of choice?

A

rhythm control (ablation or cardioversion)

42
Q

if someone who has afib is on rate control and remains symptomatic, what is the next step?

A

rhyhtm control (cardioversion)

43
Q

During what time period of afib does rhythm control improve mortality?

A

first 12 mo

44
Q

management of ED patient with unstable afib?

A

-immediate rate control
-immediate OAC then cardioversion

45
Q

how long should someone be anticoagulated (minimum) for after cardioversion?

A

4 weeks

46
Q

if afib started within ___ hours and the patient has a CHADS of ____ then cardioversion

A

48 hours, 0-1

47
Q

If a patient in afib has had symptoms less then 12 hours, but has a hx of ___ within the last 6 months, then NO cardioversion

A

CVA

48
Q

what type of afib requires anticoagulation with warfaran?

A

valvular

49
Q

what factor increases bleeding risk on anticoagulation?

A

<60kg

50
Q

what is the name of the sign for DVT that has pain with dorsiflexion of ankle?

A

Homans sign

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