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AHAD II > Primary Care Conditions/ Mental Health I > Flashcards

Primary Care Conditions/ Mental Health I Flashcards

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1
Q

Name some risk factors for hypothyroidism.

A

Iodine deficiency, women >40 years, hx of other autoimmune disorders, recent infection, surgical removal of thyroid, exposure to external radiation, postpartum, chromosomal disorders (Down’s, Turner’s, Klinefelter’s), drug-induced (amiodarone, lithium, dopamine)

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2
Q

What is the most common type of hypothyroidism?

A

Hashimoto’s thyroiditis which is autoimmune

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3
Q

What can be a common physical symptom of hypothyroidism and hyperthyroidism?

A

Goiter

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4
Q

What labs should be ordered if suspecting hypothyroidism?

A

TSH

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5
Q

If a pt’s TSH is high and hypothyroidism is suspected, what are the next steps?

A

Repeat and order a T4

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6
Q

What other labs would you consider if attempting to diagnosis hypothyroidism?

A

CBC to r/o anemia, thyroid antibodies

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7
Q

How often should TSH be checked in pregnancy?

A

Q4weeks for first half, then once between 26-32 weeks

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8
Q

When should a consult to endo be considered with a pt who has hypothyroidism?

A

Not responding to tx, children, pregnant, presence of goiter, signs of myoxedema (ER)

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9
Q

What would you expect of TSH levels in subclinical hypothyroid?

A

TSH to be slightly elevated with normal T4

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10
Q

What is the normal range of TSH?

A

0.45-4.5 mUI/L

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11
Q

What is the normal reference range for free T4?

A

9-19 pmol/L

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12
Q

What are three potential causes of hyperthyroidism?

A

Graves (autoimmune), toxic multinodular goiter, thyroid cancer

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13
Q

What is the first action that should be taken in those with hyperthyroidism?

A

Involve endo/refer to endo, order iodine reuptake test, order labs

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14
Q

What is important to remember in older adults with hyperthyroidism?

A

May exhibit less signs/symptoms. Typically demonstrate tachycardia, fatigue and weight loss

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15
Q

What is the diagnostic criteria for osteoporosis?

A

BMD of -2.5 or less

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16
Q

What bones is BMD performed on?

A

Lumbar spine, hips, forearms

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17
Q

What is the criteria for osteopenia?

A

T-score on BMD of -1 and -2.5

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18
Q

What are some risk factors for osteoporosis?

A

Hypogonadal states, low weight, smoking, low calcium intake, lack of weight-bearing exercise, family hx, excessive alcohol intake, Asian/Caucasian, advanced age, hx of fracture, secondary causes/conditions

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19
Q

Who should have a BMD completed?

A

Anyone 70 years or older, age 65-69 years with ONE risk factor, age 50-64 years with previous fracture OR 2 or more risk factors

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20
Q

What are some clinical manifestations of osteoporosis?

A

Loss of height, kyphosis, back pain, compression fractures

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21
Q

What tests can be done to assess for compression fractures and osteoporosis?

A

Compare height to previous, measure from pelvis to rib cage (if <2 cm, greater risk), measure from occiput to wall (if >5 cm=high risk), get up and go test

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22
Q

What is considered to be a significant loss of height?

A

> 6 cm over time or >2 cm from recent height

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23
Q

What is Trousseau’s sign?

A

Test that can assess for hypocalcemia. Apply BP cuff and increase pressure over 2-3 min, + would be flexion at wrist and digits

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24
Q

What is Chvotek’s sign?

A

Twitching of the facial muscles when gently tapping on the cheek

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25
What labs should be drawn when working up osteoporosis?
Comprehensive metabolic panel (Ca, phosphorus, albumin, total protein, Cr, LFT, electrolytes), TSH, Vit D, testosterone (men)
26
What is the FRAX tool?
Fracture risk assessment tool- determines absolute risk of breaking bone in next 10 years
27
What other diagnostics should be considered for osteoporosis?
BMD, DEXA, XR of lumbar/thoracic spine (assess for vertebral fracture)
28
If diagnosed with osteoporosis, how often should BMD be assessed?
Every 2 years (if on pharmacotherapy) unless clinical indication for sooner
29
What is considered a normal BMI?
15-25
30
What is considered obesity?
30-35
31
What is a tool to assess for eating disorders?
SCOFF
32
What are the three criteria for PCOS and what is required for a diagnosis?
Hyperandrogenism, ovarian dysfunction, polycystic ovaries. Must meet 2/3
33
What are some labs to consider ordering when considering PCOS?
A1C, glucose, TSH, LH, FSH, prolactin, free testosterone, lipids
34
What should be evaluated in those with PCOS?
IGT, impaired glucose tolerance assessed by 2 hour oGTT. Screen for T2DM risk
35
What is the diagnostic criteria for bulimia nervosa?
Recurrent episodes of binge eating (lack of control, large amounts), recurrent compensatory behaviours to prevent weight gain, episodes occur at least once a week x3 months, self-evaluation influenced by size
36
What are the three subclasses of obesity?
Class 1 (30-35), class 2 (35-40), class 3 (>40)
37
What tool can be used when staging obesity?
Edmonton obesity staging system (stage 0-4)
38
What is usually the first sign of osteoporosis?
Fracture
39
What is the definition of gender incongruence?
Marked/persistent incongruence b/t assigned sex and experienced gender
40
What labs should be completed before initiating hormone therapy?
CBC, ALT/AST, Cr/lytes, A1C, lipids, testosterone, estradiol, prolactin
41
What is the routine monitoring schedule for hormone therapy?
Baseline, 3 months, 6 months, annually
42
What are the characteristics of bipolar I?
Meets criteria for manic episode, may be preceded or followed by hypomanic/depressive episode
43
What characterizes bipolar II?
Pattern of depressive and hypomanic episodes, no mania
44
What are some risk factors for bipolar disorder?
Family fx of bipolar or schizophrenia, periods of high stress, drugs/alcohol misuse, major life changes
45
What are common findings of bipolar disorder?
Pt often is only seeking care for depressive episodes, don't see periods of mania as a problem
46
What does DIGFAST represent?
Helps assess mania. Distractibility, impulsivity, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness
47
What is hypomania?
Symptoms last at least 4 days, same as mania but not as severe to cause marked impairment
48
What is bipolar commonly misdiagnosed as?
Major depressive disorder
49
What are the DSM5 criteria for bipolar I?
1 or more manic episodes (DIGFAST), distinct period of mood disturbance for 1 week or more, severe mood disturbance, not attributable to another cause/medication
50
What is generalized anxiety disorder and how long must it be present for to be diagnosed?
Excessive worry, tension apprehension, and uneasiness from events/activities present on most days of week for at least 6 mo
51
To be diagnosed with GAD, 3 or more of 6 of the following symptoms must be met (most times a week for 6 or more months):
Muscle tension, restlessness/on edge, easily fatigued, difficulty concentrating, trouble falling or staying asleep, irritability
52
What does the pneumonic IMPULSIVE stand for?
Helps define the criteria for borderline personality disorder. Impulsiveness, mood instability, paranoia, unstable self-image, labile intense relationships, suicidal gestures, inappropriate anger, vulnerability, emptiness/feelings of emptiness. Must meet 5
53
When do PTSD symptoms normally begin?
3 months after traumatic event
54
What are some key components of PTSD?
Re-experiencing symptoms, avoidance, arousal and reactivity symptoms, cognition and mood symptoms
55
What diagnostic criteria must be met for PTSD?
Must have the following: one re-experiencing symptom, one avoidance symptom, two arousal and reactivity symptoms, and two cognition and mood symptoms. Must be present for longer than a month and severe enough to interfere with daily life
56
What are some risk factors for schizophrenia?
Fam hx, obstetric complications, cannabis use, psychological stress, immigration, childhood adversity, ?influenza exposure during neural development
57
What are some examples of negative symptoms?
Anhedonia, alogia, apathy, social withdrawal, flattened affect, anergia
58
What are the DSM-5 criteria for schizophrenia?
TWO of the following for a MONTH (one must be 1/2/3): delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behaviour, negative symptoms; level of functioning has to be significantly lowered; persistence symptoms for at least 6 months; r/o other disorders or causes
59
What is criteria for panic disorder as per DSM-5?
Recurrent, unexpected panic attacks AND one or more of the attacks is followed by 1 month or more of worry about future attacks and maladaptive behaviour secondary to attacks
60
What is agoraphobia?
Anxiety about having a panic attack in certain situations + these are avoided or endured with distress. Usually r/t specific situations (public transportation, open spaces, crowds, etc.)
61
What age group are specific phobias likely to begin in?
5-12 years, usually animal specific when younger and situational in older
62
What is the most common anxiety disorder?
Social anxiety disorder (SAD)
63
What are the DSM-5 criteria for SAD?
Marked anxiety about social situations where person may be scrutinized by others, fear that will be negatively evaluated by others, anxiety out of proportion, causes significant distress, normally symptoms for 6 months or greater
64
When is the mean age of onset for OCD?
Usually early, 20's- rare after 30
65
What is a common form of childhood anxiety?
Separation anxiety disorder
66
What is a tool used for screening binge eating disorder?
BEDS-7
67
What are some symptoms of myexedema coma?
Decreased LOC, periorbital edema, hypothermia
68
What lab work should be ordered for an osteoporosis work up?
CBC, Cr, calcium, ALP, TSH, serum protein electrophoresis, Vit D
69
What are some contraindications for estrogen therapy?
Unstable CVD status, estrogen-dependent cancer, end stage chronic liver disease, unable to provide informed consent
70
Name some contraindications for masculinizing hormone therapy.
Pregnancy, hormone-sensitive cancer, cardiovascular disease, unable to provide informed consent
71
Do negative or positive symptoms normally occur first in schizophrenia?
Positive
72
What is the columbia suicide severity scale?
Screening tool for suicide risk
73
What are risk factors for suicide?
Male, age over 60 years, previous attempt, family history, depression, alcohol abuse, rational thinking loss, lack of support, organized plan, serious illness/pain
74
What are three hallmark characteristics of schizophrenia?
Delusions, hallucinations, disorganized speech*
75
What FRAX score is considered high risk for fractures?
20% or greater
76
What is the difference between gender incongruence and gender dysphoria?
Gender incongruence is when there is a difference b/t assigned gender and experienced gender... dysphoria is the distress that occurs from this
77
Whom should gender affirming care be provided to?
Anyone experiencing gender dysphoria and/or gender incongruence
78
What is the DSM-5 criteria for gender dysphoria?
Marked incongruence b/t gender for at least six months and meeting 2 of following: incongruence, strong desire to be rid of primary characteristics, strong desire to be opposite gender, etc. AND associated with significant stress/impairment
79
What is the DSM-5 criteria for MDD?
5 or more of the following over 2 week period: feeling depressed, loss of interest, weight gain/loss, insomnia/hypersomnia, fatigue, psychomotor agitation or retardation, fatigue, feeling worthless, decreased concentration, thoughts of death. These symptoms must be not caused by another disorder, bipolar must be ruled out and must cause significant distress
80
What is the criteria for hypomania?
Same as with mania- must meet 3 or more of the DIGFAST criteria but must be present for 4 or more days, must be a change and must be less severe/doesn't cause impairment to functioning
81

AHAD II (5 decks)

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