EPE

Question 1

Enumerate errors due to misinterpretation of diagnostic test

Answer 1

Age
Sex
Ethnicity
Pregnancy
Body position
Chance
Lab error
Spurious (in vitro) results

Question 2

is the tendency to prematurely close decision-making process and accept diagnosis before it and other possiblities have been fully explored

Answer 2

premature closure

Question 3

Is when things are at the forefront of your mind because you have seen several cases recently or have been studying that condition

Answer 3

Availability bias

Question 4

The tendency to look for the prototypical manifestation of disease and fail to accept another atypical variant

Answer 4

Representativeness bias

Question 5

Is the tendency to look for confirming evidence to support a theory rather than looking for disconfirming evidence to refute it, even if the latter is clearly present

Answer 5

Confirmation bias

Question 6

Is the tendency to believe we know more than we actually do, placing too much faith in opinion instead of gathered evidence

Answer 6

Overconfidence bias

Question 7

the tendency to favor a diagnosis suggested by the patient rather than entertain another possibility

Answer 7

patient self-labeling

Question 8

Psychiatric patients who present with medical problems are under-assessed, under-examined and under-investigated because problems are presumed to be due to their psychiatric condition

Answer 8

Psych-out error

Question 9

Refers to the influence of either negative or positive feelings towards patients, which can affect our decision-making

Answer 9

Visceral bias

Question 10

Describes the common human tendency to rely too heavily on the first piece of information offered (the “anchor”) when making decisions

Answer 10

Anchoring

Question 11

What are the steps to reach diagnosis

Answer 11

Medical history
Physical examination
Data interpretation
Differential Diagnosis
Diagnostic studies

Question 12

How to generate a differential diagnosis

Answer 12

Collect data

Distill the data into pertinent positive and negative findings

Create a problem presentation

Ad

Question 13

Premise 1: anemia is a hemoglobin below the normal value

Premise 2: The patient has a hemoglobin below the normal value

Conclusion the patient is anemic

This reasoning is called

Answer 13

Deductive reasoning

Question 14

Evidence: the patient has vomited blood. His hemoglobin 73 g/L. He is hypotensive and tachycardia. He has complaining of epigastric pain and and duodenoscopy showed a gastric ulcer

Conclusion: we are reasonably certain that the patient has a bleeding gastric ulcer

This type of reasoning is

Answer 14

Inductive reasoning

Question 15

The patient has vomited blood. His hemoglobin is 73 g/L. He is hypotensive and tachycardia. We have no other history. The most likely cause (our best guess) is bleeding from upper gastro-intestinal tract

This type of reasoning is

Answer 15

Abductive reasoning

Question 16

Illness script includes a summary of diagnosis which should list

Answer 16

Predisposing factors
Pathophysiology
Clinical findings

Question 17

Give an account on clinical reasoning phases

Answer 17

Question 18

Causes of primary hyperlipidemia

Answer 18

Onset of premature atherosclerotic disease

Physical signs of dyslipidemia

A family history of premature atherosclerotic disease or sever hyperlipidemia

Serum cholesterol > 190 mg/dL

Question 19

Secondary (acquired) hyperlipidemia

Answer 19

Unhealthy diet and poor lifestyle regimen

Diabetes mellitus

Chronic kidney disease

Alcohol overuse

Hypothyroidism

Question 20

Screening for hyperlipidemia could be done using

Answer 20

fasting lipid profiles

Question 21

It is recommended that all men aged ___ or older and all women aged ___ or older be screened routinely for lipid disorders

Answer 21

35

45

Question 22

Modifiable risk factors for atherosclerosis

Answer 22

Type 2 diabetes
Hypertension
Smoking
Dyslipidemia
Chronic kidney disease
Obesity
Metabolic syndrome

Question 23

Used to calculate 10-year-ASCVD risk

Answer 23

Pooled Cohort Equation (PCE)

Question 24

Primary prevention: Life style changes to reduce risk of ASCVD (DIET)

Answer 24

Mediterranean diet (high in vegetables, legumes, nuts and fish) is recommended

Replace saturated fats with monosaturated and polysaturated

Patient should reduce amount of sodium

Question 25

Primary prevention: Life style changes to reduce risk of ASCVD (EXERCISE)

Answer 25

At least 150 minutes per week of moderate-intensity activities 75 minutes a week of vigorous-intensity physical activities

Question 26

Primary prevention: Life style changes to reduce risk of ASCVD (OTHER)

Answer 26

Obesity: risk for ASCVD Tobacco use: risk for ASCVD Statin use: recommended if the 10 year ASCVD risk is high, statin should be used to reduce LDL In any patient aged between 40-75 years with type 2 DM In any patient aged between 40-75 with LDL exceeding 190 Aspirin: antithrombin (not recommended)

Question 27

Secondary prevention therapy for ASCVD

Answer 27

Anti-thrombin therapy is recommended unless contraindicated

Question 28

Common cause of low back pain

Answer 28

70% Lumbar "strain" or "sprain" 10% Degenerative changes 4% Osteoporosis compression fractures Spinal stenosis

Question 29

History taking for acute low back pain steps

Answer 29

Duration of symptoms and onset Location Character or description of pain Grading of pain Relieving or exacerbating factors

Question 30

No relief with bed rest or worse at night may raise the red flag for

Answer 30

Cancer

Question 31

Morning stiffness points towards

Answer 31

Ankylosing Spondylitis

Question 32

Enumerate the red flags of acute lower back pain

Answer 32

Trauma Unexplained weight loss Neurological symptoms Ages above 50 Fever Intravenous drug use Steroid use History cancer

Question 33

What are the associated symptoms of acute lower back pain

Answer 33

Neurological history Constitutional symptoms History of cancer, IV, drug abuse or infections Any previous spinal surgery Any medications such as corticosteroids

Question 34

Numbness, weakness, bowel or bladder symptoms is a red flag for

Answer 34

Cauda equina

Question 35

Constitutional symptoms such as fever or unexplained weight loss is a red flag for?

Answer 35

Cancer

Question 36

Any medications such as corticosteroids can raise red flag for?

Answer 36

Compression fractures

Question 37

Physical examination for acute lower back pain

Answer 37

Observe gait and posture Range of motion Palpitation of spine Palpitation of sciatic notch

Question 38

Pain increase by flexion reflects usually caused by

Answer 38

mechanical stress

Question 39

Pain precipitated by extensions is indicative of

Answer 39

Spinal stenosis

Question 40

Point of tenderness may indicate a

Answer 40

fracture or infection

Question 41

Para-spinal tenderness indicates

Answer 41

muscle spasm

Question 42

Tenderness of the sciatic notch with radiation to the leg indicates

Answer 42

nerve root compression

Question 43

X-ray, CT, MRI may be warranted for

Answer 43

worsening of symptoms despite proper treatment

Question 44

is risk factor for progression to diabetes

Answer 44

Prediabetes

Question 45

Occurs in adult hood. May be asymptomatic for years, due to immune system attaching b-cell leading to absolute insulin deficiency

Answer 45

Type II diabetes

Question 46

What are the risk factors for diabetes

Answer 46

Relative with diabetes Race History of CVD Hypertension HDL and triglyceride level Physical inactivity

Question 47

Criteria for screening for diabetes or prediabetes in asymptomatic adult

Answer 47

Testing should be considered in obese adults Patients with prediabetes Women who were diagnosed with GDM tested every 3 years Other patient test begins at age 35 If test is normal, it should be repeated minimum 3 year interval people with HIV

Question 48

A1C under 6.4% FPG: 100-125 mg/dL OGTT: 140-199 mg/dL

Answer 48

prediabetes

Question 49

A1C: over 6.5% FPG: over 126 mg/dL OGTT: over 200 mg/dl

Answer 49

Diabetes

Question 50

What are the complications of diabetes?

Answer 50

Hypoglycemi

Question 51

History taking of diabetes

Answer 51

age, characteristic

Question 52

Physical examination for diabetes mellitus

Answer 52

Blood pressure, height, weight and BMI Fundoscopic examination Skin examination Comprehensive foot examination

Question 53

If A1C is not available within past 3 months what must be done?

Answer 53

Fasting lipid profile, liver function, serum creatinine, GFR

Question 54

for diabetic patient, it is recommended to eat foods containing____

Answer 54

long-chain fatty acids such as fatty fish and nuts

Question 55

What it the physical activity recommended for diabetes

Answer 55

more than 150 min/week of moderate to intense exercise with no more than 2 consecutive days without exercise Prolonged sitting should be interrupted every 30 min

Question 56

How to care for diabetic foot?

Answer 56

Identify ulcers and amputation. Patients with loss or prior ulceration or amputation must have feet inspected every visit.

Question 57

How to examine diabetic foot?

Answer 57

Inspection of the skin Assessment of foot deformities Neurological assessment Vascular assessment

Question 58

When should patients measure their blood glucose level?

Answer 58

With adjustment of their drugs Before driving During long periods of driving On sick days When there are changes in diet and exercise patterns