family medicine notes questions

Question 1

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

Answer 1

modified APT test

Question 2

name three medications used to treat early PPH

Answer 2

oxytocin
ergotamine
hemobate

Question 2

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

Answer 2

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

Question 2

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

Answer 2

irritability, insomnia

Question 3

when does the risk of fetal death from parvovirus decrease?

Answer 3

at 20 weeks gestation

Question 4

consequenses of parvovirus 19 infection in pregnancy?

Answer 4

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

Question 5

first line therapy for post natal depression

Answer 5

CBT

Question 5

what are the two tests to diagnosis PROM?

Answer 5

-ferning
-nitrazine blue

Question 6

risks associated with untreated BV in pregnancy?

Answer 6

-post partum endometritis
-preterm birht
-low birth weight

Question 7

risk factors for BV

Answer 7

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

Question 8

causes of pediatric vaginitis?

Answer 8

-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)

Question 9

name 3 indications for hip US for ddhx?

Answer 9

-breech
-family hx
-abnormal exam finding

Question 10

when do the posterior and anterior fontanelles close?

Answer 10

2 mo
18 mo

Question 11

how do you switch from the patch to the OCP?

Answer 11

take the first pill one day before taking off the patch

Question 12

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

Answer 12

3 hours

Question 12

name three shockable rhythms

Answer 12

VF
pVT
torsades de pointes

Question 12

most common site for lung cancer metastasis?

Answer 12

liver

Question 13

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

Answer 13

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

Question 14

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

Answer 14

100%

Question 14

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

Answer 14

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

Question 15

Which patients with prediabetes should consider metformin?

Answer 15

Age <60
Hx of GDM
BMI > 35

Question 16

what factors may increase an A1C (impair accuaracy)

Answer 16

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

Question 17

what factors may decrease an A1C (impair accuracy)

Answer 17

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

Question 18

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

Answer 18

SGLT2i

Question 19

what is the A1C cutoff for diabetes?

Answer 19

≥6.5%

Question 20

what is the fasting blood glucose cutoff for diabetes?

Answer 20

≥7 mmol/L

Question 21

angina criteria (3)

Answer 21

-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

Question 22

exam findings consistent with ischemic heart disease

Answer 22

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

Question 23

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

Answer 23

NO

Question 23

ECG findings suggestive of STEMI (list 2)

Answer 23

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

Question 24

what does a new Q wave suggest?

Answer 24

STEMI or NSTEMI

Question 25

name 5+ causes of elevated troponin?

Answer 25

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

Question 26

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

Answer 26

300 mg clopidegrel then 75mg OD

Question 27

which patients with hx ACS should be prescribed an ACEi?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

what are the absolute contraindications for fibrinolysis?

Answer 29

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

Question 30

within how many minutes should PCI be performed?

Answer 30

90

Question 31

within how many minutes should fibrinolysis be performed?

Answer 31

30

Question 32

what is the most common SECONDARY cause of HTN?

Answer 32

chronic renal insufficiency

Question 33

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

Answer 33

≥60

Question 34

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

Answer 34

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

Question 35

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

Answer 35

10% cross reactivity

Question 36

Management of pulmonary edema secondary to HTN emergency?

Answer 36

IV enalapril, nitroinfusion, sublingual captopril

Question 37

Management of ACEi angioedema?

Answer 37

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

Question 38

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

Answer 38

-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

Question 39

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

Answer 39

65+

Question 40

what is considered a low reccurrence rate of paroxysmal afib?

Answer 40

1-2 episodes per year

Question 41

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

Answer 41

rhythm control (ablation or cardioversion)

Question 42

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

Answer 42

rhyhtm control (cardioversion)

Question 43

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

Answer 43

first 12 mo

Question 44

management of ED patient with unstable afib?

Answer 44

-immediate rate control -immediate OAC then cardioversion

Question 45

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

Answer 45

4 weeks

Question 46

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

Answer 46

48 hours, 0-1

Question 47

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

Answer 47

CVA

Question 48

what type of afib requires anticoagulation with warfaran?

Answer 48

valvular

Question 49

what factor increases bleeding risk on anticoagulation?

Answer 49

<60kg

Question 50

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

Answer 50

Homans sign