Family Medicine Review

Question 1

Abdominal Aortic Aneurysm screening?

Answer 1

Age: 65 y/o or smoking history
How: Abdominal Ultrasound

Question 2

Lung cancer screening?

Answer 2

Age: >=55
or 30-pack-year history of smoking
or only quit 15 years ago.
How: Low-dose CT scan of the chest for lung cancer

Question 3

Colon cancer screening?

Answer 3

Do a Colonoscopy
when: start at 50 y/o, repeat every 10 years.
note: if the Family history of CC at or before 60 y/o
need to screen at 40 years old or at least 10 years before the family member was diagnosed.

Question 4

PAP smears screnning?

Answer 4

when: Start at 21 y/o, repat every 3 years

stop at 65 y/o

Question 5

Mammogram screening?

Answer 5

when: start at 40y/o, repeat every 1 or 2 years

Question 6

Osteoporosis screening?

Answer 6

when: at 65y/o
use: DEXA scan of the lumbar spine

Question 7

when do you give the Zoster vaccine?

Answer 7

At 60 y/o

Question 8

when do you give the HPV vaccine?

Answer 8

at 9 to 26 y/o

Question 9

Chlamydia + gonorrhea screening?

Answer 9

who: Females sexually active 24 y/o

Question 10

HIV screening?

Answer 10

who: anyone 15 to 65 y/o

Question 11

How to determine COPD severity?

Answer 11

Check the FEV1 (Low = poor prognosis)
Mild = FEV1 AT +80%
Moderate= 50 - 80%
Severe= 30 - 50% 
Very Severe= < 30%

Question 12

What is the TX for Mild COPD?

Answer 12

TX: Albuterol ( Short-acting B2 agonist)

Question 13

What is the TX for Moderate COPD?

Answer 13

Tx: Albuterol + long acting B2 agonist

such as: salmeterol, formoterol, arformoterol, and indacaterol.

Question 14

What is the TX for Severe COPD?

Answer 14

Tx: add Inhaled steroid. (Beclometasone,Budesonide,Fluticasone)

Question 15

what is the TX for Very Severe COPD?

Answer 15

O2 therapy

Question 16

When to add O2 therapy to a COPD pt at home?

Answer 16

O2 sat <85%

pao2 <55%

Question 17

What are GOUT presentations?

Answer 17

Acute onset of severe pain at the metatarsophalangeal joint (MTP joint) of the foot. Very painful pt will wake up from sleep.

Question 18

What is seen in the joints of a GOUT pt contain?

Answer 18

The joint will be filled with [ Uric acid crystals] which are ( Negative Birefringrnce)

Question 19

What is seen in the joints of Pseudo Gout?

Answer 19

Positive Birefringece crystals
Calcium Pyrophosphate crystals
(Rhombid shaped)

Question 20

What is the TX for GOUT pt joint?

Answer 20

TX: if the joint is hot and swollen MUST do (joint aspiration) or pt will develop Septic Arthritis

Question 21

What is the Tx for acute GOUT?

Answer 21

Acute: NSAIDS [Indomethacin, Colchicine(2nd line)]
contraindication: If pt has Kidney disease(CKD)
= GFR IS LOW or Creatinine is High

then tx is an Intra-articular steroid injection.

Question 22

What is the Tx for Chronic Gout?

Answer 22

TX: Probenecid or Allopurinol

when to use each?
check the Uric Acid in the urine
If Low = problem with excretion =
Use Probenecid

If Really High( aka the body is making too much) = Use Allopurinol
Prevent Uric Acid formation
Xanthine oxidase inhibitor

Question 23

How does Septic arthritis present?

Answer 23

Commonly in the Knee or Hip, secondary to systemic infection such as Bacteremia.

present with: An extremely tender swollen joint that is really red, with these signs
1. Can’t bear weight on the hip or bend the knee
2. Fever
3. Leukocytosis (The joint will have a WBC of 50k +, 90% Neutrophils)
Vs 10k to 15k = Gout or Rheumatoid Arthritis

TX: Arthrocentesis (1st step)
Tx: IV antibiotics

Question 24

What text to order for initial prenatal care?

Answer 24

at week 28: CBC(to check for Anemia, diabetes screening, and Rhogam shot if Rh-negative)
the shot prevents mom’s immune system from attacking babe’s blood cells.

At weeks 35-37: CBC, Urinalysis, STD, HIV, hepatitis B, a pap smear, blood typing, and rubella ,
group B strep ( do a swab of the Vagina and rectal area)= if + give Penicillin prophylaxis 4h before delivery

Question 25

How to administer the diabetes screening for prenatal care?

Answer 25

Start with 50 Gram of oral glucose Check after one hour: if 140+ ``` then advance to the next stage which is 100g of glucose dose: measure the flowing hours 1 (H=180+) 2 (H=160+) 3(H=140+) if in 2 hours it is high, then DX: Gestational Diabetes. ```

Question 26

What are the outcomes of a PAP smear?

Answer 26

1. Ascus low grade (LS il) 2.Ascus high grade (RHS il) Ascus ( means atypical squamous cells undetermined significance) next step if ascus is positive HPV test: if positive as well then do a colposcopy

Question 27

Milestones for babies at 2, 4 , 6,9,12months, 2 ,3, 5, 6years?

Answer 27

2m: Can lift their head off the ground 4m: baby can roll over 6m: can sit up on their own. 9m: can crawl or cruise 12m: baby can use one two three words other than mama, dada 2y: they know hundreds of words and two-word phrases, two zeros. 3y: thousands of words, 000 , 3-word phrases. 5y: dress yourself and write your own name 6y: you can tie your shoes, and identify left and right. note: 2-4 is when vigion and hearing testing soccer