Exam 3

Question 1

Thiamine (B1)

Answer 1

beriberi (neuropathy, edema) and Wernicke-Korsakoff syndrome (neurologic)

Question 2

Riboflavin (B2), niacin (B3), pyridoxine (B6)

Answer 2

cheilitis, angular stomatitis, glossitis (oral)

Question 3

Niacin (B3)

Answer 3

pellagra (diarrhea, dermatitis, dementia)

Question 4

Folate

Answer 4

macrocytic anemia

Question 5

Cyanocobalamin (B12)

Answer 5

peripheral neuropathy

Question 6

Vitamin D

Answer 6

rickets, osteomalacia (bone weakening)

Question 7

Vitamin A

Answer 7

night blindness

Question 8

Zinc

Answer 8

taste disturbance, impaired wound healing

Question 9

Iodine

Answer 9

goiter and hypothyroidism

Question 10

Calcium

Answer 10

fractures, tetany

Question 11

Iron

Answer 11

fatigue, pallor, pale conjunctiva, pica, koilonychia

Question 12

Vitamin C and K

Answer 12

bleeding gums, easy bruising, slow healing wounds, petechiae/purpura

Question 13

Vitamin E

Answer 13

sensory and motor neuropathy

Question 14

Fluoride

Answer 14

tooth decay, tooth discoloration

Question 15

Sodium

Answer 15

edema

Question 16

Potassium

Answer 16

weakness, vomiting

Question 17

Niacin

Answer 17

flushing

Question 18

Gastroparesis

Answer 18

Delayed gastric emptying

Eat small, frequent, low fat, low fiber meals

Question 19

Roux en y gastric bypass

Answer 19

Restrictive AND malabsorptive bariatric surgery

Eat small frequent meals and avoid simple sugars

Question 20

Celiac disease

Answer 20

Immune disorder triggered by the ingestion of gluten leading to mucosal inflammation and villous atrophy

Eat gluten free diet

Question 21

Irritable bowel syndrome

Answer 21

Functional bowel disorder characterized by chronic abdominal pain and altered bowel habits

Eat a FODMAP diet

Question 22

Inflammatory bowel disease

Answer 22

Inflammatory disorders of the GI tract that can lead to mucosal inflammation, ulceration, and malabsorption (e.g. Ulcerative colitis and Crohn’s)

Eat well balanced nutrient rich diet

Question 23

Chronic pancreatitis / pancreatic insufficiency

Answer 23

Exocrine dysfunction (digestive enzyme deficiency) can lead to protein and fat malabsorption

Avoid fat

Question 24

Renal disease

Answer 24

Poor excretion can lead to sodium and fluid retention, hyperkalemia, and hyperphosphatemia

Dietary interventions:

• Individualized protein, Na, K, PO4, and Ca intake
• Phosphorus binders
• Consult dietitian trained in renal nutrition

Question 25

Risks of iron deficiency

Answer 25

``` o Blood loss o Celiac o H pylori o Roux en y gastric bypass o PPI use (omeprazole) ```

Question 26

Risks of B12 deficiency

Answer 26

``` o Vegan o Roux en y gastric bypass o Pernicious anemia o Terminal ileum o Crohn’s o Celiac o Chronic pancreatitis o Metformin ```

Question 27

HTN

Answer 27

• Grade A o Age 18+ o Screen every 3-5 years until age 40, then annually • Annual screening if at increased risk: o High normal BP o Overweight/obese o African American

Question 28

HTN in children and adolescents

Answer 28

American Academy of Pediatrics: 3 years or older at every health care visit NHLB, Bright Futures, AHA: 3 years or older annually

Question 29

Hyperlipidemia

Answer 29

• Grade B: low dose statin o Age 40-75, no hx of CVD, 1 or greater CVD risk factor, 10 year CVD risk greater than 10% • Grade C: low dose statin o CVD risk 7.5 – 10% • Insufficient o Less than 20 years o Over 76 years with no hx of CVD

Question 30

Coronary heart disease

Answer 30

• Insufficient: hs-CRP, ankle brachial index, coronary artery calcification score o No hx of coronary heart disease • Grade D: EKG o Low risk adults • Insufficient: EKG o Intermediate or high risk adults

Question 31

Carotid artery stenosis

Answer 31

• Grade D o 10% of strokes caused by carotid artery stenosis o 1% of carotid artery stenosis is asymptomatic o Potential for overall benefit limited by low prevalence and harms

Question 32

Abdominal aorta aneurysm - MEN

Answer 32

• Grade B o 65-75 who have smoked • Grade C o 65-75 who have never smoked o Selectively offer screening, rather than routinely screen

Question 33

Abdominal aorta aneurysm – WOMEN

Answer 33

• Insufficient o 65-75 who have smoked • Grade D o 65-75 who have never smoked

Question 34

Peripheral artery disease

Answer 34

Insufficient evidence: ankle brachial index

Question 35

Aspirin prophylaxis (to prevent CVD and colorectal cancer)

Answer 35

``` • Grade B o 50-59 with 10% or greater 10 year CVD risk o Not at risk of bleeding o Have 10+ year life expectancy o Willing to take ASA daily ``` • Grade C o 60-69 with 10% or greater 10 year CVD risk o More likely to benefit if above criteria met • Insufficient evidence o Younger than 50 and older than 70

Question 36

Colorectal cancer

Answer 36

• Grade A o 50-75 • Grade C o 76-85 o Most appropriate if healthy enough to undergo tx if cancer is detected, and there are no comorbid conditions significantly limiting life expectancy o Greater benefit if never been screened

Question 37

Prostate cancer (PSA)

Answer 37

• Grade D o Over 70 • Grade C o 50-69 o Individualized after discussing benefits and harms with clinician and incorporating patient values and preferences in the decision

Question 38

Skin cancer

Answer 38

• Insufficient • Grade B o Counseling those with fair skin types • Grade C o Older than 24

Question 39

Breast cancer – USPSTF

Answer 39

• Grade C o 40-49 o Individualize • Grade B o 50-74 o Screen every 2 years

Question 40

Breast cancer – ACOG (American College of Obstetricians and Gynecologists)

Answer 40

* Offer at age 40, start no later than age 50 | * Screen every 1-2 years until age 75 then discuss discontinuation

Question 41

High risk breast cancer

Answer 41

* Annual screening mammogram starting at age 25, or 5-10 years before age of dx of affected relative * Supplemental screening breast MRI * Scheduled 6 months apart

Question 42

BRCA

Answer 42

* Use familial risk assessment tool in women with hx or family hx of breast CA * Otherwise, Grade D

Question 43

Cervical cancer (Pap)

Answer 43

• Grade A o 21-65 o Every 3 years • Grade D o Older than 65 or younger than 21 o Those with hx of hysterectomy

Question 44

Lung cancer

Answer 44

• Grade B o 55-80 with hx of smoking o Annual screening with low dose CT with 30 pack year hx, and patient currently smokes or has quit within past 15 years o Discontinue if not smoked in 15 years or develops health problem substantially limiting life expectancy or willingness to have lung sx

Question 45

The clap and gon

Answer 45

• Grade B o Screen in sexually active women 24 or younger and older women at increased risk • Insufficient for men

Question 46

Hepatitis B

Answer 46

* Grade A: screen pregnant women at first prenatal visit | * Grade B: screen those at high risk

Question 47

Hepatitis C

Answer 47

• Grade B o Those at high risk o 1 time screening to adults born between 1945-1965

Question 48

HIV

Answer 48

``` • Grade A o 15-65 o Screen younger and older if at increased risk o All pregnant women o Pre exposure prophylaxis ```

Question 49

Syphilis

Answer 49

• Grade A o Asymptomatic, non-pregnant adults and adolescents at increased risk o Early screening in pregnancy women

Question 50

Depression

Answer 50

• Grade B o General adult population, including pregnancy and postpartum women o Screen for major depressive disorder in adolescents age 12-18 o Pregnant and postpartum: refer to counseling if at increased risk • Insufficient o Children 11 or younger

Question 51

Tobacco use

Answer 51

• Grade A o Ask all adults, including pregnant women, about tobacco use o Advise to stop tobacco and provide interventions o In non-pregnant adults, provide rx for for cessation

Question 52

Tobacco use for children and adolescents

Answer 52

• Grade B o Provide interventions, education, counseling, prevent initiation of tobacco use among school aged children and adolescents

Question 53

Alcohol

Answer 53

• Grade B o 18 or older, including pregnant women o Screen for unhealthy alcohol use in primary care settings and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use • Insufficient o 12-17

Question 54

Drug use

Answer 54

• Insufficient o Screening adolescents, adults, and pregnant women o Children, adolescents not already dx with substance use disorder

Question 55

Intimate partner violence

Answer 55

• Grade B o Women of reproductive age • Insufficient o Older or vulnerable adults

Question 56

Thyroid dysfunction

Answer 56

• Insufficient evidence

Question 57

Thyroid cancer

Answer 57

• Grade D

Question 58

Osteoporosis

Answer 58

• Grade B o Women 65 and older o Postmenopausal women younger than 65 who are at increased risk of osteoporosis • Insufficient o Men

Question 59

Obesity

Answer 59

• Grade B o Adults with BMI 30 or greater o 6 years old or younger screen for obesity o Offer interventions

Question 60

Vision

Answer 60

• Grade B o Vision screening at least once in children age 3-5 for amblyopia or risk factors • Insufficient o Glaucoma o Impaired VA in 65 older

Question 61

Hearing

Answer 61

• Insufficient | o Screening for hearing loss in asymptomatic adults 50+

Question 62

Fall and fracture risk

Answer 62

* Grade B: exercise interventions for 65 older * Grade C: multifactorial interventions for 65 older * Grade D: vitamin D supplementation