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NM 717 Comps > Module 2 Primary Care Flash Cards > Flashcards

Module 2 Primary Care Flash Cards

1
Q

What BMI is considered underweight, normal, overweight, and obese?

A

Underweight: <18.5
Normal: 18.5-25
Overweight: 25-30
Obese: 30+

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2
Q

Who is considered at risk for breast CA and should be offered genetic testing?

A

Family hx:
-Breast/ovarian CA
-Breast CA prior to 50 y/o
-Bilateral breast CA
-Multiple cases of breast CA in family
-1+ family members with 2 types of BRCA related CA
-Ashkenazi Jewish ethnicity

Note: Varney p 144

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3
Q

What are the exercise recommendations per Varney?

A

150 minutes of mod-intensity aerobic activity a week with muscle training 2 days a week

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4
Q

What is an antigen?

A

An antigen is any substance that causes your immune system to produce antibodies against it. This means your immune system does not recognize the substance, and is trying to fight it off.

An antigen may be a substance from the environment, such as chemicals, bacteria, viruses, or pollen. An antigen may also form inside the body.

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5
Q

What is an antibody?

A

Antibody = a blood protein produced in response to and counteracting a specific antigen. Antibodies combine chemically with substances which the body recognizes as alien, such as bacteria, viruses, and foreign substances in the blood.

Ex: IgG, IgA, IgM, (proteins)

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6
Q

Describe the administration schedule of the Hep B vaccine:

A

3 doses over 16 weeks. 4 weeks between first two then 8 week break before last dose.

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7
Q

Describe the administration schedule of the HPV vaccine:

Who can receive it? Is dosing the same?

A

Two doses of HPV vaccine are recommended for most persons starting the series before their 15th birthday.
-The second dose of HPV vaccine should be given 6 to 12 months after the first dose.
-Adolescents who receive two doses less than 5 months apart will require a third dose of HPV vaccine.

Three doses of HPV vaccine are recommended for teens and young adults who start the series at ages 15 through 26 years, and for immunocompromised persons.
-The recommended three-dose schedule is 0, 1–2 and 6 months.
-Three doses are recommended for immunocompromised persons (including those with HIV infection) aged 9 through 26 years.

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8
Q

Describe the meaning of a Negative and Positive results of a screening test.

A

Negative: You are not at risk

Positive: You are at risk and need a diagnostic test

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9
Q

Describe the meaning of a Negative and Positive results of a diagnostic test.

A

Negative: You do not have the condition

Positive: You have the condition

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10
Q

What are the screening recommendations for Colorectal CA?

A
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11
Q

What are the screening recommendations for Hep B?

A
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12
Q

What are the screening recommendations for HTN?

A
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13
Q

What are the screening recommendations for Osteoporosis?

A
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14
Q

What are the microcytic anemias and how should they be managed?

A

IDA or Thalassemia (alpha/beta)

Draw a serum ferritin and Hcg electrophoresis

IDA (low ferritin): Iron Supplement
Thalassemia: Folate Supplement

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15
Q

What are the normocytic anemias and how should they be managed?

A

Acute blood loss anemia, Sickle cell, Anemia of chronic disease, G6PD deficiency

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16
Q

What are the macrocytic anemias and how should they be managed?

A

Folate and Vit B12 Deficiency

Draw Folate

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17
Q

Describe G6PD deficiency. Who is at risk and what meds are contraindicated with?

A

-X-linked (So rarely symptomatic in Women)
-Most often Mediterranean descent or African Descent
-Range:
Asymptomatic to
Severe acute or chronic hemolytic anemia
-Hemolysis occurs when the individual has an infection or receives oxidative drugs
-Contraindicated drugs:
Sulfa
Nitrofurantoin (Macrobid)
NSAIDs
Toluidine blue
Methylene blue
-Foods to avoid:
Fava beans
Other legumes

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18
Q

What BP is considered normal, elevated, stage 1 and stage 2 HTN?

A

Normal: <120/<80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: >140/>90

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19
Q

What labs should be checked for HTN Dx?

A

Fasting Glucose
Thyroid
Serum creatinine
Lipid profile
Sodium
Potassium
Calcium
Electrocardiogram

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20
Q

What are the treatment recommendations for normotensive BP?

A

Check annually

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21
Q

What are the treatment recommendations for elevated BP and Stage 1 HTN?

A

Non-pharm lifestyle changes and repeat BP in 3-6 months

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22
Q

What are the treatment recommendations for Stage 1 HTN with a ASCVD risk >10%?

A

Lifestyle changes and anti-HTN medication. Repeat BP in 1 month.

Meds: Thiazide diuretic, CCBS, ACE’s or ARBs

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23
Q

What are the treatment recommendations for Stage 2 HTN ?

A

Lifestyle changes and anti-HTN medication. Repeat BP in 1 month. Treat with two meds of different calsses.

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24
Q

Review all of the medication options for HTN:

A

Cholthalidone (12.5-25 mg -a thiazide diuretic) is the preferred diuretic because of long half-life

ACEs and ARBs and direct renin inhibitors should NOT be used in combination
Increased risk of hyperkalemia in CKD
D/C ACEs and ARBs in pregnancy
ACEs: lisinopril (the PRILs)
ARBs: Candesartan (the SARTANs)

Beta Blockers are not first line treatment except in CAD or Heart failure with Preserved ejection fraction. (not our people).

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25
Q

When should statins be started on a patient?

A

LDL >190

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26
Q

When should a rapid strep test be done on a patient?

A

Pharyngitis with 2 or more criteria:
Fever
Lack of cough
Tonsillar exudates
Tender Anterior cervical Adenopathy

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27
Q

What type of patient would meet criteria for moderate persistent asthma and how should it be managed by the APRN?

A

COLLABORATE!

Daily symptoms, PEF 60-79%, Some interference with ADL, Daily use of rescue meds and 2+ exacerbations a year

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28
Q

What type of patient would meet criteria for severe persistent asthma and how should it be managed by the APRN?

A

REFER!

Continual symptoms, PEF <60%, Extremely interfere with ADL, rescue med use multiple times a day and 2+ exacerbations a year

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29
Q

What is step 1 management of asthma?

A

PRN SABA (albuterol)

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30
Q

What is step 2 and step 3 management of asthma?

A

Collaborate!

Step 2: PRN SABA and daily low dose ICS

Step 3: PRN SABA and daily low dose ICS (can add a LAMA)

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31
Q

What is step 4-6 management of asthma?

A

REFER!

Step 4: Daily and PRN combo: medium dose ICS
Step 5: PRN SABA and daily high dose ICS-LABA
Step 6: PRN SABA and daily high dose ICS-LABA and oral systemic corticosteroid

Can add a LAMA to all steps

32
Q

What types of patients are high risk for TB?

A

Close contact with a person with or suspected of active TB
Foreign born from area with high TB rates
Works/resides with patients/peopel high risk for TB
Active substance use (esp IV)
Immune suppresion
Intestinal bypass/gastrectomy sx

33
Q

Who would be considered to have a positive TB screen is the induration is 15+mm?

A

Someone with no known risk factors

34
Q

Who would be considered to have a positive TB screen is the induration is 10+mm?

A

Foreign: in US <5 yr from high risk area
IV drug user
Resident/employee of high risk setting
Mycobacteriology lab personnel
Critical conditions
Children <5 and exposed to high risk adults

35
Q

Who would be considered to have a positive TB screen is the induration is 5+mm?

A

HIV+
Recent contact with TB + person
Fibrotic changes on CXRAY
Organ transplant recipient
Immunosuppressed

36
Q

Pt c/o right upper quadrant pain. What conditions do we suspect and what exams should be done?

A

-Gallbladder (radiates to shoulder/scapula)
-Murphy’s sign
-Liver (for Pre-E)

37
Q

Pt c/o right lower quadrant pain. What conditions do we suspect and what exams should be done?

A

-Appendix
-Mcburney’s point/Roving’s Sign
-Right ovary

38
Q

Pt c/o sternum/Epigastric pain. What conditions do we suspect and what exams should be done?

A

GERD
Ulcers/Gallbladder

39
Q

Explain the antibody IgG:

A

This is from a past infection
It can cross the placenta

40
Q

Explain the antibody IgM:

A

This is from a current infection
It cannot cross the placenta

41
Q

Explain what HBsAg indicated:

A

“Hep B surface antigen”

an antigen is a foreign substance that induces an immune response in the body (acute Active Hep B or carrier (chronic active state)

42
Q

Explain what IgM anti-HBc indicates:

A

“IgM anticore antibody”

remember - IgM - “I’ve got it and I’m Miserable”/Mama
marker of recent/acute infection within the last 6 months (won’t get this from vaccine)

43
Q

Explain what Total Anti-HBc indicates:

A

“IgG anticore antibody”

marker for past or current infection

44
Q

Explain what Anti-HBs indicates:

A

“Anti Hepatitis B surface antibody”

marker of an immune response to HBV

45
Q

What lab results indicate an acute active Hepatitis infection?

A

Positive: HBsAg, HBeAg, IgM Anti-HBc, Total Anti-HbC and high Hep B serum titer

46
Q

What lab results indicate a chronic active (carrier) Hepatitis infection?

A

Positive: HBsAg and Total Anti-Hbc

47
Q

What lab results indicate vaccination to Hepatitis infection?

A

Positive: Anti-HBs

48
Q

What do the following lab values indicate?

HBsAG: Negative
anti-HBc: Positive
anti-HBs: Positive

A

Immune from natural infection

49
Q

What do the following lab values indicate?

HBsAG: Negative
anti-HBc: Negative
anti-HBs: Positive

A

Immune due to vaccination

50
Q

What do the following lab values indicate?

HBsAG: Positive
anti-HBc: Positive
IgM anti-HBc: Positive
anti-HBs: Negative

A

Acutely infected

51
Q

What do the following lab values indicate?

HBsAG: Positive
anti-HBc: Positive
IgM anti-HBc: Negative
anti-HBs: Negative

A

Chronically Infected

52
Q

What is the next step for a patient that tests positive for HBsAg?

A

Report to Perinatal HBV Prevention Program. Recommend screening for all household & sexual contacts. Order HBeAg, HBV DNA concentration, ALT. Obtain physician consult for consideration of co-management or referral.

53
Q

What is the diagnostic criteria for an acute UTI?

A

One of the following symptoms: Urgency, frequency, dysuria, puprapubic tenderness, fever is <65

AND

1) + ur cx of >100,000 CFU/ml with <2 species
OR
2) + ur culture of >10,000 with <2 species and a UA of [leukocyte, nitrie, pyuria (>3 BC), microorganisms seen on gram stain]

54
Q

What is the first line treatment for acute UTI?

A

Nitrofurantoin (Macrobid) or TMP-SMX (Bactrim)

55
Q

What is the diagnostic criteria for Metabolic Syndrome?

A

**Dont memorize!! Just review

Any of the 3 following=Diagnosis:
-Wast circumference >77 cm in women (34.5 inches)
-Serum triglycerides >150 g/dL or treatment to reduce triglycerides
-Serum HDL <50 mg/dL or treatment to reduce
-BP >130/85 mm HG or tx for HTN
-Fasting Plasma Glucose >110 mg/dL or treatment for hyperglycemia

56
Q

Explain the cause of DM-I.

A

Results from beta-cell destruction, usually leading to absolute insulin deficiency

57
Q

Explain the cause of DM-II.

A

Resulting from progressive loss of pancreatic beta-cell insulin secretion in the face of increased insulin resistance

58
Q

What is the diagnostic criteria for DM?

A

Any one of the following is positive twice!

A1C >6.5%+
Fasting Glucose >126 mg/dl
2h Glucose Test > 200 mg/dl+

59
Q

What are the long acting insulins?

A

Lantus, Levemit, Tresbia

60
Q

What is the rapidacting insulins?

A

Humalog

61
Q

What labs indicate Hyperthyroid?

What are the clinical features?

A

Low TSH and High T4

Anxiety, diarrhea, fatigue, goiter, sweating, heat intolerance, irreg. menses, increased appetitie, lid lag, ophthalmopathy, palpitations, tremor, weakness, warm moist skin

62
Q

What labs indicate Hypothyroid?

What are the clinical features?

A

High TSH and low T4

Bradycardia, cold intolerance, constipation, delay in DTRs, depression, dryness, thinning hair, edema, fatiue, goiter, HA, lethargy, loss of appetitie, muscle weakness, cramping, pain, menorrhagia/amenorrhea, pallor, slow speech, weight gain

63
Q

What are the red flag symptoms of headaches?

A

Rapid onset
Severe symptoms
High fever
Severe vomiting without nausea
Neck stiffness
Neuro S/S
Vision changes
Worsening HA
Inc. in meds to control pain
Associated with exercise or position change

64
Q

What is the diagnostic criteria for migraine without aura?

A

Symptoms present 5+ times for 4-72 hours including two of the following

-Unilateral location
-Pulsating quality
-Moderate or severe pain intensity
-Aggravated by or causing avoidance of routine physical activity

Symptoms during a HA
-Nausea/vomiting
-Photo and phonophobia

65
Q

What is the diagnostic criteria for migraine with aura?

A

Symptoms present at least 1 times!
-Visual
-Sensory
-Speech
-Motor
-Brainstem
-Retinal

-One aura occuring gradually ober >5 min
-Aura symptom lasting 5-60min
-Symptom is unilateral
-HA accompanies or follows aura within 60 min

66
Q

What preventaitive therapies can be used for migraines?

A

TCA
Anti-epileptic
Beta-blockers
CCB
ACE-I
RB

67
Q

What abortive therapies can be used for migraines?

A

NSAIDs
Tylenol
Caffeine
Triptans (Imitrex, Zomig)
Serotonin 5HT Receptor Agonist (Amerge)

68
Q

What are the red flags associated with low back pain?

A

Hx of trauma
IV drug use
Unexplained weight loss
CA Hx
Long term steroid use
Fever
Incontinence
Intense localized pain on exam

69
Q

What level of vitamin D is considered deficient?

A

< 10 ng/ML

70
Q

What is the diagnostic criteria for depression?

A

Depressed mood OR anhedonia + any from below for a total of 5
Sleep disorder (insomnia or hypersomnia)
2. Interest deficit or lack of feeling pleasure
3. Guilt (worthlessness, hopelessness, regret)
4. Energy deficit (fatigue or loss of energy nearly every day)
5. Concentration deficit
6. Appetite disorder (increased or decreased)
7. Psychomotor retardation or agitation
8. Suicidality (recurrent thoughts of death)
Which occur nearly everyday for 2 weeks & are severe enough to impede function

71
Q

What medications can be used for depression?

A

SSRI’s (all have wt gain & mild sexual dysfunction as S/E)
Citalopram (Celexa)- higher risk of sexual dysfunction
Escitalopram (Lexapro) - may cause QT prolongation
Fluoxetine (Prozac) - may worsen anxiety
Paroxetine (Paxil)- NOT IN PREGNANCY- sexual dysfunction, wt gain worse
Sertraline (Zoloft)- (best for breastfeeding)

SSNRI’s
Duloxetine (Cymbalta)-
Venlafaxine (Effexor)- inc BP., more agitation & GI upset than SSRIs

NDRI’s
Bupropion (Wellbutrin, Zyban), may be stimulating, no sexual s/e, lowers seizure threshold, also used for smoking cessation.

72
Q

What are the characteristics of generalized anxiety?

A

-Excessive anxiety and worry about 2+ domains of activities or events - occurs on more days than not, for 3 months or more.
-Anxiety & worry are difficult to control
-Anxiety & worry are associated with restlessness and/or muscle tension
-Anxiety & worry are associated with marked avoidance of activities or events with possible negative outcomes,
excessive time & effort preparing for activities or events with possible negative outcomes,
marked procrastination in behavior or decision making due to worries,
& repeatedly seeking reassurance due to worries.

73
Q

What drugs are teratogenic?

A

Androgens & Testosterone: Danocrine (Danazol)
Tetracyclines: doxycycline
Sulfonamides: Bactrim/ Septra
Aminoglycosides: Gentamicin, Streptomycin, Kanamycin
Anticonvulsants: Tegretol, Dilantin, Tridione, Depakene- valporic acid
ACE inhibitors: Captopril, Enalapril, Lisinopril
Antidepressants: Paroxetine (Paxil)
Antineoplastics: Methotrexate
Anti-thyroid drugs: PTU, Methimazole (Tapazole)
Aspirin (& NSAIDS): > 150 mg daily
Benzodiazepines: Alprazolam (Xanax), Diazepam (Valium)
Corticosteroids: -Medrol
Coumarin (Warfarin)
Ergotamine (Cafergot)
Folic Acid antagonists: Tegretol, Dilantin
Misoprostol (Cytotec)
Accutane
Statins: Lipitor

74
Q

What are the grades of systolic murmurs?

A

Grade 1: Very faint
Grade 2: Quiet but heard immediately
Grade 3: Moderately loud
Grade 4: Palpable thrill
Grade 5: Thrill that can be heard with stethoscope partially off the chest
Grade 6: Thrill that can be heard with stethoscope off the chest

75
Q

What are the grades of diastolic murmurs?

A

Grade 1: Barely audible
Grade 2: Faint but immediately audible
Grade 3: Easily Heard
Grade 4: Very loud

76
Q

What signs indicate pathologic murmurs?

A

-Diastolic or pansystolic murmur or any murmur above grade 3
-Intensifies with exercise or Valsalva maneuver
-Mid-or late systolic click, associated with MVP
-Cyanosis
-Jugular vein distension
-Hepatomegaly
-Pedal edema
-Diminished femoral pulses or unequal blood pressure in L and R arms

NM 717 Comps (31 decks)

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