Aging Wisely
To assess the complex health needs of this population, family physicians should use the age-friendly health systems model, which is based on the 4Ms framework. What do the 4Ms stand for?
4Ms = What Matters, Medication, Mentation, Mobility. These four topics are relevant regardless of a patient's specific medical problems.
This is the most common cause of respiratory distress in term newborns within the first few hours of life.
transient tachypnea of the newborn (TTN)
Resistant hypertension is defined as uncontrolled blood pressure despite the use of this many medications, ideally including a diuretic.
resistant htn = uncontrolled BP despite the use of 3 medications
This is the most common cause of vertebral compression fractures in older adults.
osteoporosis
The primary goal of HIV treatment is achieving this laboratory outcome.
viral suppression
The article emphasizes that addressing this issue is one of the highest-yield interventions to reduce harm in older adults.
Polypharmacy
Respiratory distress beginning immediately after birth in a preterm infant is most consistent with this diagnosis.
respiratory distress syndrome (RDS)
RDS is caused by immature lung development and surfactant deficiency, most often in preterm newborns. It is also a possible sequelae of meconium aspiration syndrome.
RDS often presents immediately after delivery with signs of respiratory distress. Symptoms progress over the first 48 hours and can lead to respiratory failure due to ongoing atelectasis. In addition to respiratory distress, diminished breath sounds and crackles may be appreciated on examination. By 24 hours, chest radiography can show a diffuse, symmetrical reticulogranular (ground-glass) appearance, air bronchograms, or a whiteout appearance in preterm neonates if very few alveoli are expanded or pulmonary edema is present.
This condition is a common and often underrecognized contributor to resistant hypertension.
Obstructive sleep apnea
What does conservative management of vertebral compression fractures entail? Name two of many interventions
Modalities of conservative therapy include pharmacologic therapy (NSAIDs, acetaminophen), supportive bracing, physical rehabilitation, nerve root blocks, and facet joint injections.
Individuals with HIV have a _ to _% higher fracture risk and experience fractures up to 10 years earlier than the general population. HIV contributes to bone loss through chronic inflammation and increased osteoclast activity.
10-50%
Risk is greatest in the first 1 to 2 years after initiating ART, especially with tenofovir disoproxil fumarate (Viread), which is associated with a 2% to 6% decline in bone mineral density.
consider DEXA scan
This brief screening tool is commonly used in primary care to assess cognition as part of mentation. What is the sensitivity and specificity of this test to detect cognitive impairment?
Mini-Cog.
The Mini-Cog has 73% sensitivity and 84% specificity (positive likelihood ratio = 4.56, negative likelihood ratio = 0.32) to detect cognitive impairment, encompassing mild cognitive impairment and dementia.
This initial step should be performed for all newborns immediately after delivery before further intervention.
warm, dry, stimulate
Reliable forms of contraception should be used when a patient who could become pregnant is taking this class of antihypertensive.
BONUS for 300 points: In patients attempting to become pregnant or who are pregnant, treatment with a ___ or ___diuretic is preferred initially, with a ___ as a third-line option.
ACE/ ARB should be avoided in pregnant/ or could be pregnant patient
-significantly lower birth weight and gestational ages
-may be associated with an increased risk for miscarriage
-fetal malformations
BONUS: In patients attempting to become pregnant or who are pregnant, treatment with a dihydropyridine CCB or thiazide diuretic is preferred initially, with a beta blocker as a third-line option.
Regarding vertebral compression fracture, surgical intervention with vertebroplasty or kyphoplasty may be considered when pain persists for ____(range) weeks despite conservative intervention.
4-10 weeks
In women with PCOS trying to conceive, this medication induces ovulation in about 75% of patients but results in pregnancy in only about half of those treated.
clomiphene
Clomiphene citrate induces ovulation by blocking estrogen receptors at the hypothalamus, which reduces negative feedback and increases pulsatile GnRH secretion, leading to enhanced pituitary FSH and LH release that drives follicular development and ovulation.
What are three (of many) potentially modifiable risk factors for dementia in midlife?
high LDL, depression, HTN, diabetes, physical inactivity, smoking, obesity, excessive alcohol consumption
What are 3 (of many) causes of respiratory distress in the newborn?
respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis. Less common causes are pneumothorax, congenital heart disease, and congenital diaphragmatic hernia.
Optimal first-line pharmacotherapy for hypertension consists of standard doses of which three classes of antihypertensives?
dihydropyridine CCB, an ARB or ACEI, and a thiazide diuretic.
In general, an ARB is recommended over an ACEI given the comparable effectiveness but lower adverse effect rates associated with ARBs, specifically cough and angioedema
Antithrombotic therapy with ____ is recommended for embolic stroke due to atrial fibrillation; ____ therapy is more commonly used for the treatment of nonembolic stroke.
anticoagulants used for embolic stroke
antiplatelet agents used for ischemic stroke
A patient with well-controlled chronic conditions is on multiple medications, but now experiences falls and dizziness. AAFP guidance emphasizes addressing this by first doing this before adding or escalating therapy.
medication review and deprescribing if appropriate (or minimizing polypharmacy)
The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative from the US Centers for Disease Control and Prevention and the American Geriatrics Society recommends screening for fall risk with three questions...
Do you feel unsteady when standing or walking?
Do you have concerns about falling?
Have you fallen in the past year?
A newborn with respiratory distress immediately at birth, hypoxia requiring oxygen, and diffuse ground-glass opacities is most likely deficient in this substance.
Surfactant
After confirming adherence and excluding secondary causes, this medication is recommended as the preferred fourth-line agent for resistant hypertension.
Spironolactone. In patients with resistant hypertension, a mineralocorticoid receptor antagonist is the preferred fourth-line option.
In minor stroke or high-risk TIA, this combination therapy should be started within 72 hours and continued for 21 to 30 days before transitioning to monotherapy.
dual anti-platelet therapy (DAPT) with low-dose aspirin (50–100 mg) and clopidogrel (75 mg) should be started within 72 hours and continued for 21 to 30 days followed by lifelong antiplatelet monotherapy to reduce recurrence.
Which two GLP-1 receptor agonists are approved by the US Food and Drug Administration for treating obesity in adolescents 12 years and older with a BMI at the 95th percentile or higher?
semaglutide and liraglutide (Saxenda)