Family Medicine - Aquifer 11-20 Test |
Questions Solved 100% Correct
What views should be ordered when evaluating a knee for OA? what would you expect
to see?
AP, lateral, standing anterior weight-bearing
-joint space narrowing
-subchondral sclerosis (hardening of tissue beneath cartilage)
-osteophytes
-subchondral cysts (fluid-filled sacs in marrow)
NOTE: not necessary to get XR if OA highly suspected
What are the recommendations for initial management of OA?
lifestyle:
-aerobic and/or resistance exercise
-PT
-weight loss! (obesity = major risk factor)
meds:
-NSAIDs - 1st line; diclofenac most effective; lowest dose for shortest period
-APAP - up to 4g/day
-topicals e.g. diclofenac (A), capsaicin (B)
When might intra-articular steroid injections be considered in a pt with OA?
- if knee joint is inflamed - swelling, pain - for short term relief
- NO MORE than 4 injections per year, 1 per month
- TAC preferred
What are the recommendations regarding glucosamine, chondroitin in tx of OA?
A recommendation to not use - unlikely to provide benefit
What centrally-acting agent can be used in management of OA?
duloxetine (B) - efficacy in tx of OA when used alone or in conjunction with NSAIDs
What medication can be recommended for older patients with moderate-severe OA pain
uncontrolled by first line agents? what potential s/e should be discussed?
,tramadol - synthetic opioid analgesic, binds to mu receptors and weakly inhibits NE and
5HT reuptake
common = constipation
severe s/e = lowering seizure threshold in pts with epilepsy, serotonin syndrome, respiratory
depression, angioedema, bronchospasm, dependency
What testing can be used to evaluate for carpal tunnel?
PE:
carpal tunnel compression test (30 sec)
tinel sign (tapping over median n. @ wrist)
phalen test (flex wrist by placing dorsal surfaces of hands together in front of pt for 30-60sec)
Additional:
Electrodiagnostic test (nerve conduction study) = test of choice, usually only done if sx fail to
improve with conservative measures, motor dysfunction present or thenar atrophy seen
NOTE: dx usually based on clinical picture alone (weakness digit 1, 2, 3 w/ palmar sx,
weak thumb abduction, hypalgesia)
What are some second-line choices for chronic pain control if a patient has not responded to
conservative tx?
-opioids: in carefully selected patients w/o identifiable risk for opioid abuse/misuse and
who understand the risks
-TCAs: can be helpful with neuropathic pain, limited by anticholinergic, GI and neurologic
side effects; CI in patients with CV disease or conduction problems
-SSRIs/SNRIs: can be helpful in treating comorbid depression
-anticonvulsants e.g. gabapentin, pregabalin - for neuropathic pain
What components should be included in an adolescent interview?
HEEADSSS
home, education/employment, eating, activities, drugs, sexuality, suicide/depression,
safety/violence
CT screening recommendations, women:
-ALL sexually active women age 24 and younger
-sexually active women >25yo who are at increased risk
, increased risk = hx of STI, new or multiple partners, inconsistent condom use, exchange sex
for goods
CT screening recommendations, men:
-sexually active young me in settings with high
prevalence -in men with high risk behaviors
Varicella vaccine schedule:
12-15 months, 4-6 yrs second dose
2 doses Meningococcal
vaccine:
11-12yo with booster at 16
2 doses
Folic acid supplementation in women of child-bearing age: recommendation
ALL women "planning or capable of pregnancy" take a daily 400-800mcg folic acid supplement
increase dose if:
-1mg in pt with DM or epilepsy
-4mg if child with previous NTD
What screening recommendations are part of routine preconception counseling?
carrier screening based on ethnic background: SCD, thalassemia, tay-sachs
carrier screening based on fhx:
CF, nonsyndromic hearing loss
infectious diseases:
HIV, syphilis
immunizations - HBV, rubella, varicella
counseling - toxo, CMV, parvo
environmental, medical (e.g. stop ACEi/ARBs, thiazides, switch from warfarin to heparin if
DVT, avoid benzos), lifestyle assessments
What is Naegele's rule?
Questions Solved 100% Correct
What views should be ordered when evaluating a knee for OA? what would you expect
to see?
AP, lateral, standing anterior weight-bearing
-joint space narrowing
-subchondral sclerosis (hardening of tissue beneath cartilage)
-osteophytes
-subchondral cysts (fluid-filled sacs in marrow)
NOTE: not necessary to get XR if OA highly suspected
What are the recommendations for initial management of OA?
lifestyle:
-aerobic and/or resistance exercise
-PT
-weight loss! (obesity = major risk factor)
meds:
-NSAIDs - 1st line; diclofenac most effective; lowest dose for shortest period
-APAP - up to 4g/day
-topicals e.g. diclofenac (A), capsaicin (B)
When might intra-articular steroid injections be considered in a pt with OA?
- if knee joint is inflamed - swelling, pain - for short term relief
- NO MORE than 4 injections per year, 1 per month
- TAC preferred
What are the recommendations regarding glucosamine, chondroitin in tx of OA?
A recommendation to not use - unlikely to provide benefit
What centrally-acting agent can be used in management of OA?
duloxetine (B) - efficacy in tx of OA when used alone or in conjunction with NSAIDs
What medication can be recommended for older patients with moderate-severe OA pain
uncontrolled by first line agents? what potential s/e should be discussed?
,tramadol - synthetic opioid analgesic, binds to mu receptors and weakly inhibits NE and
5HT reuptake
common = constipation
severe s/e = lowering seizure threshold in pts with epilepsy, serotonin syndrome, respiratory
depression, angioedema, bronchospasm, dependency
What testing can be used to evaluate for carpal tunnel?
PE:
carpal tunnel compression test (30 sec)
tinel sign (tapping over median n. @ wrist)
phalen test (flex wrist by placing dorsal surfaces of hands together in front of pt for 30-60sec)
Additional:
Electrodiagnostic test (nerve conduction study) = test of choice, usually only done if sx fail to
improve with conservative measures, motor dysfunction present or thenar atrophy seen
NOTE: dx usually based on clinical picture alone (weakness digit 1, 2, 3 w/ palmar sx,
weak thumb abduction, hypalgesia)
What are some second-line choices for chronic pain control if a patient has not responded to
conservative tx?
-opioids: in carefully selected patients w/o identifiable risk for opioid abuse/misuse and
who understand the risks
-TCAs: can be helpful with neuropathic pain, limited by anticholinergic, GI and neurologic
side effects; CI in patients with CV disease or conduction problems
-SSRIs/SNRIs: can be helpful in treating comorbid depression
-anticonvulsants e.g. gabapentin, pregabalin - for neuropathic pain
What components should be included in an adolescent interview?
HEEADSSS
home, education/employment, eating, activities, drugs, sexuality, suicide/depression,
safety/violence
CT screening recommendations, women:
-ALL sexually active women age 24 and younger
-sexually active women >25yo who are at increased risk
, increased risk = hx of STI, new or multiple partners, inconsistent condom use, exchange sex
for goods
CT screening recommendations, men:
-sexually active young me in settings with high
prevalence -in men with high risk behaviors
Varicella vaccine schedule:
12-15 months, 4-6 yrs second dose
2 doses Meningococcal
vaccine:
11-12yo with booster at 16
2 doses
Folic acid supplementation in women of child-bearing age: recommendation
ALL women "planning or capable of pregnancy" take a daily 400-800mcg folic acid supplement
increase dose if:
-1mg in pt with DM or epilepsy
-4mg if child with previous NTD
What screening recommendations are part of routine preconception counseling?
carrier screening based on ethnic background: SCD, thalassemia, tay-sachs
carrier screening based on fhx:
CF, nonsyndromic hearing loss
infectious diseases:
HIV, syphilis
immunizations - HBV, rubella, varicella
counseling - toxo, CMV, parvo
environmental, medical (e.g. stop ACEi/ARBs, thiazides, switch from warfarin to heparin if
DVT, avoid benzos), lifestyle assessments
What is Naegele's rule?
