Family Medicine Shelf (USPSTF + Blueprints + AAFP Questions & Answers)
Screening for AAA Correct Ans - Men 65-75 who have ever smoked (A)
Test used to screen for AAA Correct Ans - Abdominal duplex ultrasonography
Treatment for AAA Correct Ans - >5.5 cm --> surgery
3.0-5.4 cm --> repeated surveillance Q3-12 months
Growth >1.0 cm/yr --> surgery
Screening for Alcohol Misuse Correct Ans - Persons older than 18 years
Screening Tests for Alcohol Misuse Correct Ans - AUDIT, AUDIT-C, or number of times person drank >5 (4 if woman or older than 65) drinks in the past year
Treatment for Alcohol Misuse Correct Ans - Behavioral Counseling interventions
Recommendation for Aspirin Usage Correct Ans - Men 45-79 years old (MI protection)
Women 55-79 (Stroke protection)
*Benefit of MI reduction must outweigh the risk of GI hemorrhage
Risk Factors For GI Hemorrhage Correct Ans - Men
Other NSAID usage
Hx of GI ulcer
Uncontrolled HTN
Anticoagulation
Screening for Asymptomatic Bacteriuria Correct Ans - Women at 12-
16 weeks of pregnancy or first prenatal visit if farther along Screening Test for Asymptomatic Bacteriuria Correct Ans - Urine culture
Dipstick and microscopy have poor PPV and NPV
Treatment for Asymptomatic Bacteriuria Correct Ans - Nitrofurantoin
Prophylactic Aspirin for the Prevention of Colon Cancer Correct Ans - The USPSTF DOES NOT recommend this due to risk of GI hemorrhage
Bacterial Vaginosis Screening in Pregnant Women Correct Ans - The USPSTF DOES NOT recommend this due to lack of evidence that it reduces mortality or morbidity
Amsel Criteria Correct Ans - Need 3/4:
1. Fishy odor with addition of KOH
2. Vaginal pH >4.7
3. Clue cells on wet mount
4. Thin, homogenous discharge
Treatment of BV Correct Ans - Oral Metronidazole or oral Clindamycin
or
Vaginal Metronidazole or Vaginal Clindamycin creams
Screening for Bladder Cancer Correct Ans - The USPSTF DOES NOT recommend this due to lack of accurate screening methods
Screening for HTN Correct Ans - Adults > 18 years
Diagnosis of HTN Correct Ans - >140 systolic or >90 diastolic
Must have 2 different BP readings that are elevated over a period of 1-several weeks
Categories of BP Correct Ans - Normal = <120/<80
PreHTN = 120-129/80-89
Stage 1 HTN = 140-159/90-99
Stage 2 HTN = 160+/100+
Major CV Risk Factors Correct Ans - HTN Obesity
Dyslipidemia
DM
Cigarette smoking
Inactivity
Age >55 (men) or >65 (women
Family History of premature CVD: <55 (men) and <65 (women)
Causes of HTN Correct Ans - Sleep Apnea
Drug-induced (diuretics, cyclosporine, glucocorticoids, amiodarone)
Chronic kidney disease
Primary Aldosteronism (Conn's Syndrome)
Cushing's Syndrome
Pheochromocytoma (MEN II and III)
Coarctation of aorta (Turner's)
Thyroid/Parathyroid disease
Goal BPs for Treatment (JNC8) Correct Ans - <140/90 for adults <60 years without CKD
<150/90 for adults >60 years without CKD
<140/90 for all ages with DM, but no CKD
<140/90 for all ages with CKD +/- DM
Treatment of HTN for Non-Black without CKD Correct Ans - Thiazide Diuretic
ACE-I
ARB
CCB
Treatment of HTN for Black without CKD Correct Ans - Thiazide Diuretic
CCB
Treatment of HTN for All Races with CKD +/- DM Correct Ans - ACE-I
ARB
BRCA-Related Cancer Screening Correct Ans - All women with family members who had breast, ovarian, tubal, and/or peritoneal cancers Medications for Breast Cancer Risk Reduction Correct Ans - Offer tamoxifen or raloxifene to women at high risk with low risk for adverse side effects
Mammography Screening Correct Ans - Women 50-74: biennial (every
other year)
Women under 50: Take the patient's factors into context and weigh benefits and risks
Women >75: not recommended to get screening
Breastfeeding recommendations Correct Ans - Interventions to educate and encourage women during pregnancy and postnatal period to breastfeed
Carotid Artery Stenosis Screening Correct Ans - USPSTF DOES NOT recommend screening for the general population for asymptomatic carotid stenosis
Diagnostic Test for Carotid Artery Stenosis Correct Ans - Ultrasonography of Carotid Artery with Doppler flow
High Intensity Statin Correct Ans - Lowers LDL-C by >/=50%
Atorvostatin 40-80 mg
Rosuvostatin 20-40 mg
Medium Intensity Statin Correct Ans - Lowers LDL-C by 30-50%
Atorvostatin 10-20 mg
Rosuvostatin 5-10 mg
Simvastatin 20-40 mg
Provastatin 40-80 mg
Lovastatin 40 mg
Fluvastatin 40 mg BID
Low Intensity Statin Correct Ans - Lowers LDL-C by </=30%
Pravastatin 10-20 mg
Lovastatin 20 mg
Screening for AAA Correct Ans - Men 65-75 who have ever smoked (A)
Test used to screen for AAA Correct Ans - Abdominal duplex ultrasonography
Treatment for AAA Correct Ans - >5.5 cm --> surgery
3.0-5.4 cm --> repeated surveillance Q3-12 months
Growth >1.0 cm/yr --> surgery
Screening for Alcohol Misuse Correct Ans - Persons older than 18 years
Screening Tests for Alcohol Misuse Correct Ans - AUDIT, AUDIT-C, or number of times person drank >5 (4 if woman or older than 65) drinks in the past year
Treatment for Alcohol Misuse Correct Ans - Behavioral Counseling interventions
Recommendation for Aspirin Usage Correct Ans - Men 45-79 years old (MI protection)
Women 55-79 (Stroke protection)
*Benefit of MI reduction must outweigh the risk of GI hemorrhage
Risk Factors For GI Hemorrhage Correct Ans - Men
Other NSAID usage
Hx of GI ulcer
Uncontrolled HTN
Anticoagulation
Screening for Asymptomatic Bacteriuria Correct Ans - Women at 12-
16 weeks of pregnancy or first prenatal visit if farther along Screening Test for Asymptomatic Bacteriuria Correct Ans - Urine culture
Dipstick and microscopy have poor PPV and NPV
Treatment for Asymptomatic Bacteriuria Correct Ans - Nitrofurantoin
Prophylactic Aspirin for the Prevention of Colon Cancer Correct Ans - The USPSTF DOES NOT recommend this due to risk of GI hemorrhage
Bacterial Vaginosis Screening in Pregnant Women Correct Ans - The USPSTF DOES NOT recommend this due to lack of evidence that it reduces mortality or morbidity
Amsel Criteria Correct Ans - Need 3/4:
1. Fishy odor with addition of KOH
2. Vaginal pH >4.7
3. Clue cells on wet mount
4. Thin, homogenous discharge
Treatment of BV Correct Ans - Oral Metronidazole or oral Clindamycin
or
Vaginal Metronidazole or Vaginal Clindamycin creams
Screening for Bladder Cancer Correct Ans - The USPSTF DOES NOT recommend this due to lack of accurate screening methods
Screening for HTN Correct Ans - Adults > 18 years
Diagnosis of HTN Correct Ans - >140 systolic or >90 diastolic
Must have 2 different BP readings that are elevated over a period of 1-several weeks
Categories of BP Correct Ans - Normal = <120/<80
PreHTN = 120-129/80-89
Stage 1 HTN = 140-159/90-99
Stage 2 HTN = 160+/100+
Major CV Risk Factors Correct Ans - HTN Obesity
Dyslipidemia
DM
Cigarette smoking
Inactivity
Age >55 (men) or >65 (women
Family History of premature CVD: <55 (men) and <65 (women)
Causes of HTN Correct Ans - Sleep Apnea
Drug-induced (diuretics, cyclosporine, glucocorticoids, amiodarone)
Chronic kidney disease
Primary Aldosteronism (Conn's Syndrome)
Cushing's Syndrome
Pheochromocytoma (MEN II and III)
Coarctation of aorta (Turner's)
Thyroid/Parathyroid disease
Goal BPs for Treatment (JNC8) Correct Ans - <140/90 for adults <60 years without CKD
<150/90 for adults >60 years without CKD
<140/90 for all ages with DM, but no CKD
<140/90 for all ages with CKD +/- DM
Treatment of HTN for Non-Black without CKD Correct Ans - Thiazide Diuretic
ACE-I
ARB
CCB
Treatment of HTN for Black without CKD Correct Ans - Thiazide Diuretic
CCB
Treatment of HTN for All Races with CKD +/- DM Correct Ans - ACE-I
ARB
BRCA-Related Cancer Screening Correct Ans - All women with family members who had breast, ovarian, tubal, and/or peritoneal cancers Medications for Breast Cancer Risk Reduction Correct Ans - Offer tamoxifen or raloxifene to women at high risk with low risk for adverse side effects
Mammography Screening Correct Ans - Women 50-74: biennial (every
other year)
Women under 50: Take the patient's factors into context and weigh benefits and risks
Women >75: not recommended to get screening
Breastfeeding recommendations Correct Ans - Interventions to educate and encourage women during pregnancy and postnatal period to breastfeed
Carotid Artery Stenosis Screening Correct Ans - USPSTF DOES NOT recommend screening for the general population for asymptomatic carotid stenosis
Diagnostic Test for Carotid Artery Stenosis Correct Ans - Ultrasonography of Carotid Artery with Doppler flow
High Intensity Statin Correct Ans - Lowers LDL-C by >/=50%
Atorvostatin 40-80 mg
Rosuvostatin 20-40 mg
Medium Intensity Statin Correct Ans - Lowers LDL-C by 30-50%
Atorvostatin 10-20 mg
Rosuvostatin 5-10 mg
Simvastatin 20-40 mg
Provastatin 40-80 mg
Lovastatin 40 mg
Fluvastatin 40 mg BID
Low Intensity Statin Correct Ans - Lowers LDL-C by </=30%
Pravastatin 10-20 mg
Lovastatin 20 mg
