Ambulatory/preventive medicine

Question 1

What are 5As of smoking cessation?

Answer 1

ASK - about smoking status
ADVISE - to quit
ASSESS - willingness to quit
ASSIST - with making a plan
ARRANGE - for follow up

5 Rs: motivate patients with this:
Relevance, Risks, Rewards, Roadblocks, and Repetition

Question 2

What are stages of change for quitting preparation?

Answer 2

1. Pre-contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance

Question 3

What are screening things for alcoholism

Answer 3

Men: CAGE (cut down, annoyed, guilty, eye opener)
Women: TACE (tolerance, annoyed, cut down, eye opener)
Pregnancy: TWEAK (tolerance, worried, eye opener, amnesia, kut down)

Question 4

What did women’s health initiative show?

Answer 4

combined HRT risks: incr risk breast cancer, clots/stroke, heart attack, DECR risk colon cancer and fractures.
- released data early and caused fear of HRT! mostly studied in 60-70 y/o women

Estrogen: incr stroke, decreased fractures

Question 5

What are blood types ABO?

Answer 5

O POS=most common
AB neg= least common
Universal donor=O neg
Universal receipient=AB Pos

Question 6

What is metabolic syndrome?

Answer 6

BIG WACKY HIGH BLOOD SUGARS TRIGGER:
- BP (130/85)
- waist circumference 88cm/35in
- HDL <50
- blood sugar >100
- triglycerides >150
- need 3/5 for ddx

Question 7

What are NY heart association classifications

Answer 7

Class 1=no limitations
Class 2= slight limitations
Class 3= marked limitations
Class 4=bedrest

Question 8

What is asthma severity by FEV1?

Answer 8

intermittent and mild persistent: FEV1>80%
- moderate persistent: FEV 1 60-80%
- seere persistent: FEV1 <60%

Question 9

How do you interpret serologic testing for hepatitis B?

Answer 9

Hbs Ag=acute or chronic infection
Anti-HBc=appears at onset of symptoms in acute infection, measure of IgG and IgM and persists for life
Anti-HBs=recovery and immunity from hep B
IgM Anti-HBc=recent infection w/ Hep B (<6 months), only order if concerned for acute infection

Question 10

What do these test results indicate?
HBsAg neg
Anti-HBc neg
Anti-HBs neg

Answer 10

no infection but susceptible

Question 11

What do these test results indicate?
HBsAg neg
Anti-HBc pos
Anti-HBs pos

Answer 11

Immune due to natural infection

Question 12

What do these test results indicate?
HBsAg neg
Anti-HBc neg
Anti-HBs pos

Answer 12

Immune due to vaccination

Question 13

What do these test results indicate?
HBsAg pos
Anti-HBc pos
IgM Anti-HBc pos
Anti-HBs neg

Answer 13

acute infected
- IgM pos so <6 months infection and Anti-HBs neg means haven’t recovered!!

Question 14

What do these test results indicate?
HBsAg pos
Anti-HBc pos
IgM Anti-HBc neg
Anti-HBs neg

Answer 14

Chronically infected
- If Anti-HBs neg, do NOT have immunity.

Question 15

What is stage 1 and stage 2 hypertension

Answer 15

Stage 1: BP 140-159/90-99
Stage 2: 160-179/100-109
Hypertensive crisis: >180/110

Question 16

What is considered in fRAX score (risk of osteoporotic fracture in next 10 years)?

Answer 16

Age
Previous fractures
Soking
Sex
Fam hx
Alcohol intake
BMI
Rheumatoid arthritis
Steroid use
- Treat when >3% risk of hip fracture or >20% risk of major fracture

Question 17

What is principle of beneficence?

Answer 17

obligation of physician to act for the benefit of the patient and supports a number of moral rules to protect and defend the right of others, prevent harm, remove conditions that will cause harm, help persons with disabilities, and rescue persons in dange

Question 18

What is non-maleficence?

Answer 18

Nonmaleficence is the obligation of a physician not to harm the patient. This simply stated principle supports several moral rules − do not kill, do not cause pain or suffering, do not incapacitate, do not cause offense, and do not deprive others of the goods of life. The practical application of nonmaleficence is for the physician to weigh the benefits against burdens of all interventions and treatments, to eschew those that are inappropriately burdensome, and to choose the best course of action for the patient

Question 19

What is principle of justice?

Answer 19

Justice is generally interpreted as fair, equitable, and appropriate treatment of persons. Of the several categories of justice, the one that is most pertinent to clinical ethics is distributive justice. Distributive justice refers to the fair, equitable, and appropriate distribution of health-care resources determined by justified norms that structure the terms of social cooperation

Question 20

What is a case control study used for?

Answer 20

to determine if there is an association between an exposure and a specific health outcome.

compares two groups of people: those with the disease or condition under study (cases) and a very similar group of people who do not have the disease or condition (controls). i.e. link between tobacco use and lung cancer

Question 21

What are risk factors for heparin-induced thrombocytopenia?

Answer 21

1) the duration of heparin therapy (>5 days)
2) the type (UFH > LMWH > fondaparinux) and dosage of heparin
3) the indication for treatment (surgical and trauma patients at highest risk)
4) the patient’s sex (female > male).

Question 22

How do you diagnose appendicitis in pregnancy?

Answer 22

The initial study of choice is ultrasound with graded compression of the right lower quadrant

• then non-contrast MRI