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When should screening for colon cancer begin in the patient with no family history of colon cancer?

Screening for colon cancer should begin at 50 with colonoscopy every 10 years. Annual fecal occult blood testing, sigmoidoscopy every 5 years, and barium enema are also options.


What are the screening mammography recommendations for breast cancer?

Every 1–2 years from age 40 and over. Breast examination by physician for ages 20–30, every 3 yrs. Patients with multiple first–degree relatives with breast cancer should receive prophylactic tamoxifen.


What is the prophylaxis for hepatitis A for travelers?

If a patient is leaving within 2 wks to a nonindustrialized country, vaccine and immune serum globulin are given. A booster shot given 6 months after the initial vaccination confers immunity for 10 years.


Which travelers should receive hepatitis B vaccine?

Patients who will work with indigenous, engage in sex, receive medical/ dental care, on remain abroad >6 mth in a country where prevalence is intermediate or high.


What is the recommended prophylaxis for malaria for travelers?

Traveling to Mexico, Central America (except Panama), or Caribbean, chloroquine is prophylaxis for malaria. For travelers to areas where chloroquine resistance common, mefloquine recommended.


At what age is meningococcal vaccine usually given?

Meningococcal is routinely given at age 11.


What are the recommendations for prevention of traveler''s diarrhea?'

Patients who experience loose stools without fever or blood may take loperamide. Treatment with a fluoroquinolone or azithromycin is reserved for patients with bloody diarrhea.


What are the recommendations for tetanus and diphtheria vaccination in adults who were never vaccinated?

Adults who were never vaccinated should receive three doses, the first two are given 1 to 2 months apart, with the third dose given 6 to 12 months later. A booster vaccination should be given every 10 years for life.


What are the recommendations for influenza vaccination?

Annually for adults >50. Cardiopulmonary disease, diabetes, hemoglobinopathy, or who are in chronic care facilities should receive annual. Pregnant women who will be in 2nd or 3rd trimester during influenza season.


What are the indications for pneumococcal vaccination?

Adults >65; sickle–cell, splenectomy, cardiopulmonary disease, alcoholism, cirrhosis, Alaskan natives, Native Americans; immunocomp (heme malignancies, CRF, nephrotic, HIV; immunosuppressives).


What are the indications for hepatitis B vaccination?

IV drug abuse, male homosexuality, household or sexual contact with hepatitis B carriers, frequent exposure to blood, chronic liver disease. Immunity can be confirmed serologically.


What are the recommendations for hepatitis A vaccine?

Hepatitis A vaccine is recommended for travelers to endemic areas, day–care employees, homosexual men, and chronic liver disease.


What are the indications for varicella vaccine?

Varicella vaccine is recommended for all adults who lack a history of childhood infection; should not be given to immunocompromised or pregnant because it is live attenuated.


What are the recommendations for measles, mumps, rubella vaccine?

Measles, mumps, rubella vaccine is a live attenuated vaccine given in childhood. Healthy adults should receive 1 dose if never vaccinated. Pregnant and immunocompromised not vaccinated.


What are the recommendations for osteoporosis screening?

All women older than age 65 should be given DEXA scans every 1–2 years. Begin at age 60, if there is low body weight or increased risk of fractures.


What are the recommendations for screening for abdominal aortic aneurysm?

Ultrasound should be given once in male smokers older than age 65.


What are the recommendations for cholesterol screening?

Cholesterol screening should begin at age 35 in men and 45 in women who have no risk factors. For patients with risk factors for coronary artery disease, screening should be done routinely after age 20.


What are the recommendations for screening for diabetes?

Obesity, impaired fasting glucose, African–Americans, native Americans and/or positive family history.


What is the criteria for the diagnosis of diabetes?

Diabetes mellitus is diagnosed when two fasting are greater than 126 mg/dL, or when a random glucose is >200 mg/dL.


What clinical test should be used to screen for alcohol abuse?

CAGE: Have you ever felt the need for Cut down? Have you ever felt Annoyed by criticism of your drinking? Have you ever Guilty about your drinking? Have you ever taken Eye opener? Positive is 2 yes


What pathological conditions are associated with hyperprolactinemia?

Excess of prolactin occurs with prolactinomas (most common functioning pituitary adenomas, 60% of pituitary tumors.


What medications cause hyperprolactinemia?

Decreased inhibitory action of dopamine caused by drugs that block dopamine synthesis (phenothiazines, metoclopramide) and dopamine–depleting agents (alpha–methyldopa).


What is the presentation of hyperprolactinemia?

Women have galactorrhea, amenorrhea/oligomenorrhea, osteoporosis, infertility, gynecomastia; men have hypogonadism, erectile dysfunction, decreased libido, gynecomastia and infertility.


How is hyperprolactinemia diagnosed?

Always exclude pregnancy, lactation, hypothyroidism and medications before starting the evaluation of hyperprolactinemia. Prolactin levels >100 ng/mL suggest probable pituitary adenoma.


What is the management of hyperprolactinemia?

For prolactinomas: cabergoline or bromocriptine (dopamine agonist) reduce prolactin levels. Surgery for adenomas not responsive to cabergoline or bromocriptine, or if the tumor causes neurologic effects.


What is acromegaly?

Excessive secretion of growth hormone in an adult. In children, gigantism occurs. In adults acromegaly occurs, which is bony and soft tissue overgrowth. Pituitary adenoma that overproduces growth hormone. Only 1% are malignant.


How is acromegaly diagnosed?

The best initial test is insulin–like growth factor–1 levels. Confirmatory testing involves the measurement of GH after 100 g of glucose is given orally.


What is the management of acromegaly?

Transsphenoidal surgery. Hypopituitarism occurs after surgery in 10–20%. Octreotide is a somatostatin analog that reduces GH in two thirds of patients and causes partial tumor regression in 20–50% of patients.


What are the causes of hypopituitarism?

Tumors, cysts, sarcoidosis, Tb, syphilis, eosinophilic granuloma, Hashimoto, gastric atrophy. Trauma, radiation, surgery, infections, hypoxia. Sheehan postpartum necrosis, hemochromatosis, amyloidosis.


What are the signs of hypopituitarism?

Amenorrhea, genital atrophy, loss pubic hair. Growth fail. Thyrotropin deficiency: hypothyroidism. Adrenocorticotropin def: fatigue, anorexia, wt loss, decreased skin pigment, hypotension, hypoNa.