UPDATED 2024 Family med aquifer Test Questions With Answers

When is a patient at risk for hereditary breast cancer? - ANSWER- 1st relative has it: parent or sibling Recommendations for breast exams: - ANSWER- self: meh. no discernable advantage Clinical: USPTF = Insufficient ACS = every three years if 20-40 and every year if 40 Cervical cancer screening 30-65: - ANSWER- every three years if cytology alone 5 years if cytology plus HPV screening 21-29 year old cervical cancer screening: ` - ANSWER- every 3 years women older than 65 cervical cancer screening: - ANSWER- can opt out if had adequate screening within last 10 years = 3 normal paps or 2 consecutive normal with negative HPV who should get more frequent cervical cancer screening? - ANSWER- compromised immunity, are HIV positive, have a history of cervical intraepithelial neoplasia grade 2, 3 or cancer cancer screening: - ANSWER- annual low dose CT in patients who have smoked more than 30 yrs and and 55-80 years old NOTE: must have been smoking within last 15 years or currently smoking diagnostic tests for found breast masses: - ANSWER- cystic = FNA Solid = mammography NOTE: can use US to determine solid vs cystic. If benign, follow with mammography and exams Advanced sleep phase syndrome: - ANSWER- patient becomes drowsy at 6 or 7 pm, sleep a normal 8 or so hours, then wake around 3-4 am. if they STAY UP, then they still awaken at 3-4, and it can be difficult to distinguish from insomnia When is napping OK? - ANSWER- limit to 30-45 mins and are STILL able to sleep at night WHy does alcohol not help you sleep? - ANSWER- initially has sedative effect followed by stimulant like effect = wakes you up after a couple hours Snacks that may help with sleep when eaten before bed: - ANSWER- warm milk, bananas, light foods that have tryptophan in them risk factors of suicide in elderly: - ANSWER- widowed/alone lack confidante poor health poor sleep stressful events NOTE: 75% of elderly that committed suicide had been to PCP in last month and were not caught Contrast suicide rates by age: - ANSWER- attempts do NOT increase, but completions DO increase Which ethnic group in the US is at highest risk for suicide? - ANSWER- American indian/native alaskan 1.5X the normal rate, 8th leading cause of death in these two groups aged 15-35 Requirements to Dx major depression: - ANSWER- 5/9 of the SIGECAPS for 2 weeks or more MUST HAVE: depressed mood or loss of interest in things to be considered assessing severity of suicidal ideation: - ANSWER- SAD PERSONS Sex - male Age 19 or 45 Depression Dx Previous attempts Ethanol or substance abuse Rational thinking impaired Social supports not present Organized plan for suicide No significant other Sickness 4-6 = outpatient is okay option 7-10 = hospitalization is warranted Who should be screened for depression? - ANSWER- all adults, but especially diabetics or others with chronic diseases Major limiatation to the geriatric depression screen: - ANSWER- it does not work well in demented patients, so also screen for dementia as well two ways to screen for dementia: - ANSWER- MMSE Mini Cog exam -- faster and more specific than MMSE Most common side effects of SSRIs - ANSWER- Headaches sleep disturbances GI problems (diarrhea) Sexual dysfunction hyponatremia, Serotonin syndrome, GI bleeds can also occur NOTE: increased risk of fall in elderly, and can adversely affect bone density two antidepressants that prolong QT - ANSWER- citalopram, escitalopram Describe depression in hispanics: - ANSWER- often underdiagnosed, especially compared to whites will often have complaint of myalgias/fatigue rather than mood complaints immigrant hispanics have LESS depression than US born have more percpetual distortion (NOT psychosis) than non hispanics Risk factors for elder abuse: - ANSWER- dementia dependence of caretaker on elder substance abuse by caretaker Social isolation of elder from people other than caretaker Caretaker and elder living together NOTE: level of dependence of elder and their stress does not really afffect the likelihood of elder abuse Describe how long to give antidepressants: - ANSWER- first episode: 9-12 mo. subsequent = 2-3 years if relapse elderly and multiple relapses, be considering continuous therapy