Family Medicine Aquifer Cases Study
Questions Solved 100% Correct
How effective are oral medications, such as bupropion (Wellbutrin, Zyban,
Budeprion) or varenicline (Chantix), in helping smokers quit? - ANSWER - somewhat;
quit rate at 12 months is 1.5-3x higher than placebo quit rate
Shingrex - ANSWER - given to every adult > 50 y/o
Tetanus vaccine recommendations - ANSWER - substitute a one-time dose of Tdap
for Td for ages 11 to 64 and then boost with Td every 10 years
Indications for exercise stress testing - ANSWER - asymptomatic male patients > 45 y/o
with one or more risk factors
,What EKG changes suggest CAD? - ANSWER - convex ST segment elevation
- Q waves (past MI)
- ST segment depression
Grade A screening recommendations for 55 y/o asymptomatic male who smokes (4)
- ANSWER - colorectal cancer
- blood pressure
- tobacco smoking cessation
- HIV (all pt aged 15-65 y/o)
Grade B recommendations for 55 y/o asymptomatic male who smokes (8) - ANSWER
- EtOH use
- unhealthy drug use
- depression
- DM (40 - 70 y/o w/ high BMI)
- aspirin (adults 50 - 59 w/ 10 year CVD risk > 10%)
- Statin (40 - 75 w/ 10 year CVD evet risk > 10%)
- Hep C (18-79)
- Lung cancer (if 20+ years of smoking within last 15 years)
Grade C recommendations for 55 y/o asymptomatic male who smokes (8) - ANSWER -
prostate cancer screening in males 55 - 69 y/o
- skin cancer prevention (behavioral counseling is recommended for those with fair skin)
Diabetes screening guidelines - ANSWER - grade B -
all adults age 40 to 70 who are overweight or obese
Aspirin use recommendations - ANSWER - grade C: adults aged 40 - 59 w/ > 10% 10-
year CVD risk
- grade D: do not use for primary prevention in adults 60+ years
,Satin use for primary prevention guidelines - ANSWER - grade B
- adults aged 40 - 75 w/ no hx CVD OR 1 or more risk factors (DM, smoking,
HTN, dyslipidemia) AND 10 year CVD risk > 10%
Hep B and C screening guidelines - ANSWER *grade B
- Hep B --> only those at increased risk of infection
- Hep C --> at least once per lifetime for adults aged 18 - 79; repeat testing if increased
risk
Signs of dyslipidemia - ANSWER Corneal arcus, xanthelasmas, acanthosis nigricans
Signs of atherosclerosis - ANSWER - decreased peripheral
pulses - carotid bruit
What diameter indicates melanoma? - ANSWER > 6 mm
Bupropion schedule for smoking cessation - ANSWER -set quit date
- start taking one pill a day one week before the quit date
- after three days, take one pill 2x/day for four days
- quit smoking on quit date; continue 1 pill 2x/day for about 2 months
- gradually stop pills after 2 months
Common causes of insomnia in elderly (11) - ANSWER - environmental issues
- drugs/alcohol/caffeine
- sleep apnea
- parasomnias
- disturbances in sleep-wake cycle
- psychiatric disorders
- Symptomatic cardiorespiratory disease
- pain
, - GERD
- hyperthyroidism
- advanced sleep phase syndrome (ASPS)
What is the top treatment recommendation for elderly patients with insomnia?
- ANSWER CBT
Risk factors for completed suicide - ANSWER - male sex
- age
- previous attempts
- military service
Risks/SE of SSRIs/SNRIs - ANSWER - headaches
- sleep disturbances
- GI sx
- sexual dysfunction
Rare:
- hyponatremia d/t SIADH
- serotonin syndrome
- GI bldg
Citalopram and escitalopram can cause ______. - ANSWER QT prolongation
Risk factors for elder abuse - ANSWER - dementia
- shared living situation of elder and abuser
- caregiver substance abuse or mental illness
- heavy dependence of caregiver on elder
- social isolation of the elder from people other than the abuser
Questions Solved 100% Correct
How effective are oral medications, such as bupropion (Wellbutrin, Zyban,
Budeprion) or varenicline (Chantix), in helping smokers quit? - ANSWER - somewhat;
quit rate at 12 months is 1.5-3x higher than placebo quit rate
Shingrex - ANSWER - given to every adult > 50 y/o
Tetanus vaccine recommendations - ANSWER - substitute a one-time dose of Tdap
for Td for ages 11 to 64 and then boost with Td every 10 years
Indications for exercise stress testing - ANSWER - asymptomatic male patients > 45 y/o
with one or more risk factors
,What EKG changes suggest CAD? - ANSWER - convex ST segment elevation
- Q waves (past MI)
- ST segment depression
Grade A screening recommendations for 55 y/o asymptomatic male who smokes (4)
- ANSWER - colorectal cancer
- blood pressure
- tobacco smoking cessation
- HIV (all pt aged 15-65 y/o)
Grade B recommendations for 55 y/o asymptomatic male who smokes (8) - ANSWER
- EtOH use
- unhealthy drug use
- depression
- DM (40 - 70 y/o w/ high BMI)
- aspirin (adults 50 - 59 w/ 10 year CVD risk > 10%)
- Statin (40 - 75 w/ 10 year CVD evet risk > 10%)
- Hep C (18-79)
- Lung cancer (if 20+ years of smoking within last 15 years)
Grade C recommendations for 55 y/o asymptomatic male who smokes (8) - ANSWER -
prostate cancer screening in males 55 - 69 y/o
- skin cancer prevention (behavioral counseling is recommended for those with fair skin)
Diabetes screening guidelines - ANSWER - grade B -
all adults age 40 to 70 who are overweight or obese
Aspirin use recommendations - ANSWER - grade C: adults aged 40 - 59 w/ > 10% 10-
year CVD risk
- grade D: do not use for primary prevention in adults 60+ years
,Satin use for primary prevention guidelines - ANSWER - grade B
- adults aged 40 - 75 w/ no hx CVD OR 1 or more risk factors (DM, smoking,
HTN, dyslipidemia) AND 10 year CVD risk > 10%
Hep B and C screening guidelines - ANSWER *grade B
- Hep B --> only those at increased risk of infection
- Hep C --> at least once per lifetime for adults aged 18 - 79; repeat testing if increased
risk
Signs of dyslipidemia - ANSWER Corneal arcus, xanthelasmas, acanthosis nigricans
Signs of atherosclerosis - ANSWER - decreased peripheral
pulses - carotid bruit
What diameter indicates melanoma? - ANSWER > 6 mm
Bupropion schedule for smoking cessation - ANSWER -set quit date
- start taking one pill a day one week before the quit date
- after three days, take one pill 2x/day for four days
- quit smoking on quit date; continue 1 pill 2x/day for about 2 months
- gradually stop pills after 2 months
Common causes of insomnia in elderly (11) - ANSWER - environmental issues
- drugs/alcohol/caffeine
- sleep apnea
- parasomnias
- disturbances in sleep-wake cycle
- psychiatric disorders
- Symptomatic cardiorespiratory disease
- pain
, - GERD
- hyperthyroidism
- advanced sleep phase syndrome (ASPS)
What is the top treatment recommendation for elderly patients with insomnia?
- ANSWER CBT
Risk factors for completed suicide - ANSWER - male sex
- age
- previous attempts
- military service
Risks/SE of SSRIs/SNRIs - ANSWER - headaches
- sleep disturbances
- GI sx
- sexual dysfunction
Rare:
- hyponatremia d/t SIADH
- serotonin syndrome
- GI bldg
Citalopram and escitalopram can cause ______. - ANSWER QT prolongation
Risk factors for elder abuse - ANSWER - dementia
- shared living situation of elder and abuser
- caregiver substance abuse or mental illness
- heavy dependence of caregiver on elder
- social isolation of the elder from people other than the abuser
