Foundations of Clinical Practice Flashcards
(90 cards)
1
Q
Indication for recombinant zoster vaccine
A
Age ≥50 years or 19-49 years and immunodeficient/immunocompromised
MKSAP 20
2
Q
What is substituted judgment?
A
Surrogate care decisions based on patient’s previously expressed preferences and values
MKSAP 20
3
Q
HIV screening frequency for average-risk persons
A
One-time screening
MKSAP 20
4
Q
Perioperative management of biologic agents for non-SLE rheumatologic disease
A
Withhold preoperatively; perform surgery just after the next dose would have been due
MKSAP 20
5
Q
USPSTF recommendation for primary prevention of preeclampsia in ASCVD risk I patients
A
Low-dose aspirin
MKSAP 20
6
Q
Influenza formulation recommended for adults ≥65 years of age
A
Inactivated (standard or high dose) or recombinant influenza vaccine
MKSAP 20
7
Q
Recommended minimum weekly physical activity
A
150-300 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity
MKSAP 20
8
Q
Increase in disease probability with positive LRs of 2, 5, and 10
A
15%, 30%, and 45%
MKSAP 20
9
Q
What is the responsibility when a colleague is impaired or unable to carry out clinical responsibilities?
A
Report to appropriate authorities and identify appropriate sources of help
MKSAP 20
10
Q
Perioperative management of aspirin for secondary prevention
A
Continue perioperatively for elective noncardiac surgery
MKSAP 20
11
Q
Indication for annual influenza vaccination
A
All adults
MKSAP 20
12
Q
Role of vitamin D supplementation in fall prevention
A
None
MKSAP 20
13
Q
Initial agent for radiation-induced vomiting
A
Serotonin antagonists (ondansetron, granisetron)
MKSAP 20
14
Q
Recommendation for enteral/parenteral nutritional support at end of life
A
Avoid
MKSAP 20
15
Q
Components of patient decision-making capacity
A
Can understand relevant information and communicate choice consistent with information and stated values
MKSAP 20
16
Q
Intervention when a medical error is discovered
A
Error disclosure with compassion and concern for patient
MKSAP 20
17
Q
What is the bias that occurs automatically and unintentionally?
A
Implicit bias
MKSAP 20
18
Q
Number one cause of preventable disease, disability, and death in U.S.
A
Smoking
MKSAP 20
19
Q
Study type providing the highest level of evidence
A
Systematic review
MKSAP 20
20
Q
CDC-recommended HIV screening frequency for MSM
A
At least annually
MKSAP 20
21
Q
Rate of diagnostic error in clinical decision making
A
10%
MKSAP 20
22
Q
Age indications for HPV vaccination
A
11-12 years or between 13 and 26 years
MKSAP 20
23
Q
USPSTF criterion for DM screening in patients aged 35-70 years
A
Obesity/overweight
MKSAP 20
24
Q
Time to delay elective noncardiac surgery after stroke or TIA
A
At least 6 months
MKSAP 20
25
Prerequisite for genetic testing
Genetic counseling
| MKSAP 20
26
Patients who should undergo preoperative screening for OSA
All patients
| MKSAP 20
## Footnote
OSA stands for Obstructive Sleep Apnea, a condition that can complicate anesthesia and surgery.
27
Strongest clinical study design
Randomized controlled trial
| MKSAP 20
## Footnote
This design minimizes bias and allows for the comparison of different interventions.
28
Perioperative management of untreated subclinical hypothyroidism
Proceed to surgery without further testing/treatment
| MKSAP 20
## Footnote
Subclinical hypothyroidism generally does not require intervention prior to surgery.
29
Four-step quality improvement method
Plan-Do-Study-Act (PDSA) cycle
| MKSAP 20
## Footnote
This method is commonly used for continuous quality improvement in healthcare.
30
Test's ability to accurately detect those with the disease
Sensitivity
| MKSAP 20
## Footnote
Sensitivity measures the proportion of true positives among those with the disease.
31
Only indication for routine preoperative spirometry
Planned lung resection
| MKSAP 20
## Footnote
Routine spirometry is not indicated for all patients but is necessary for those undergoing lung surgery.
32
USPSTF screening criterion for intimate partner violence
Women of childbearing age
| MKSAP 20
## Footnote
The United States Preventive Services Task Force recommends screening in this demographic due to higher risk.
33
Contraindication to elective surgery in liver disease
MELD score >20
| MKSAP 20
## Footnote
MELD stands for Model for End-Stage Liver Disease, and a score above 20 indicates significant liver dysfunction.
34
Minimum preoperative DAPT duration after bare metal stent placement
14-30 days
| MKSAP 20
## Footnote
DAPT refers to dual antiplatelet therapy, crucial for preventing stent thrombosis.
35
Postoperative rigidity, fever, confusion, and autonomic instability in patient with Parkinson disease
Parkinsonism-hyperpyrexia syndrome (dopamine agonist withdrawal)
| MKSAP 20
## Footnote
This syndrome can occur after abrupt withdrawal of dopaminergic medications.
36
Typical time to restart DOACs postoperatively after major surgery
48-72 hours
| MKSAP 20
## Footnote
DOACs are Direct Oral Anticoagulants, and timing for resumption is critical to balance bleeding risk and thromboembolism.
37
Essential geriatric prescribing principle
Frequent review of medication necessity
| MKSAP 20
## Footnote
This principle helps to minimize polypharmacy and adverse drug reactions in older adults.
38
Rapid-acting depression treatment useful at end of life
Methylphenidate
| MKSAP 20
## Footnote
Methylphenidate can provide quick relief of depressive symptoms in terminally ill patients.
39
Prophylactic device for pressure injury
Advanced static mattress or mattress overlay
| MKSAP 20
## Footnote
These devices help redistribute pressure and prevent pressure ulcers in at-risk patients.
40
Genetic testing before prescribing allopurinol
HLA-B*58:01
| MKSAP 20
## Footnote
Testing for this allele helps predict the risk of severe hypersensitivity reactions to allopurinol.
41
AHA-recommended number of hours of sleep in adults
7
| MKSAP 20
## Footnote
The American Heart Association emphasizes adequate sleep for cardiovascular health.
42
Indication for one-time abdominal aortic aneurysm screening
Men aged 65-75 years who have ever smoked
| MKSAP 20
## Footnote
This population is at increased risk for abdominal aortic aneurysms.
43
Systems factors that contribute to diagnostic error
Communication policies and practices, resources, practice structure
| MKSAP 20
## Footnote
These systemic issues can lead to failures in diagnosis and patient care.
44
Contributors of suboptimal care transitions
Poor communication among team; inadequate information transfer and patient education
| MKSAP 20
## Footnote
Effective transitions are critical for continuity and quality of care.
45
Perioperative management of chronic β-blocker therapy
Continue β-blocker unless prohibited by hypotension
| MKSAP 20
## Footnote
Maintaining β-blockers can help prevent cardiovascular complications during surgery.
46
Likely the greatest indicator of health outcomes
Socioeconomic position
| MKSAP 20
## Footnote
Socioeconomic factors significantly influence overall health and access to care.
47
Indications for deferral of surgery in patients with hypertension
Evidence of end-organ dysfunction or BP >180/110 mm Hg
| MKSAP 20
## Footnote
These conditions increase the risk of perioperative complications.
48
Role of preoperative placement of IVC filter in VTE prophylaxis
None
| MKSAP 20
## Footnote
Current guidelines do not support the routine use of IVC filters for VTE prophylaxis before surgery.
49
Role of adding aspirin for primary prevention of ASCVD in a patient aged >59 years
None
| MKSAP 20
## Footnote
Aspirin is not recommended for primary prevention in this age group due to risk of bleeding.
50
Nutrition factors predictive of poor surgical outcomes
15% weight loss over 6 months, BMI <18.5, serum albumin level <3.0 g/dL (30 g/L)
| MKSAP 20
## Footnote
These indicators reflect nutritional status and can influence surgical recovery.
51
Initial preoperative assessment of patients with ≥1% risk for MACE
Assessment of functional capacity
| MKSAP 20
## Footnote
MACE stands for major adverse cardiac events.
52
Time to stop DOACs preoperatively
2-3 days before surgery
| MKSAP 20
53
Impact of palliative medicine
Improved quality of life, symptoms, mood, and caregiver satisfaction
| MKSAP 20
54
Basic principles of medical ethics
Beneficence, nonmaleficence, respect for patient autonomy, justice
| MKSAP 20
55
Indication for preoperative urinalysis
Suspected UTI, planned urologic procedure
| MKSAP 20
56
Lead-time bias
Survival time appears longer because the screened patient was diagnosed earlier
| MKSAP 20
57
Self-reflection and discovery to build honesty and trustworthy relationships
Cultural humility
| MKSAP 20
58
USPSTF-recommended BP screening frequency in adults aged ≥40 years
Annually
| MKSAP 20
59
Prevalence of U.S. adults who use vitamins or dietary supplements
50%
| MKSAP 20
60
USPSTF-recommended means of calculating CV risk
Pooled Cohort Equations
| MKSAP 20
61
Elderly fall prevention interventions
Exercise, discontinuing/decreasing centrally acting medications, modifying home environment
| MKSAP 20
62
Most common type of preventable medical error
Medication errors (prescribing/transcribing, dispensing, administering/taking, or monitoring)
| MKSAP 20
63
Tdap vaccination recommendation for pregnant patients
Between 27 and 36 weeks' gestation for every pregnancy
| MKSAP 20
64
Treatment of established pressure injuries
Wound care, protein supplements, pressure-reducing surfaces, hydrocolloid and foam dressings
| MKSAP 20
65
Postoperative transfusion threshold in orthopedic and cardiac surgery patients
Hemoglobin level of 8 g/dL (80 g/L)
| MKSAP 20
66
Mnemonic for never events in health care
WSPEs (wrong-site, wrong-procedure, wrong-patient errors)
| MKSAP 20
67
Indication for one-time screening for hepatitis C
All patients aged 18-79 years
| MKSAP 20
68
Indication for preoperative echocardiography in patients with valvular disease
Moderate to severe valve disease without TTE within last year or change in clinical status
| MKSAP 20
69
Population-based screening for carotid artery stenosis
USPSTF grade D
| MKSAP 20
70
Indications for cardiac catheterization before noncardiac surgery
Same as those for patients not undergoing surgery
| MKSAP 20
71
Routine preoperative laboratory testing in low-risk surgery (cataract surgery, hernia repair)
None
| MKSAP 20
72
Length-time bias
Survival time appears longer because screening detects indolent disease
| MKSAP 20
73
Indication for screening for chlamydia and gonorrhea in women
Age ≤24 years and sexually active
| MKSAP 20
74
Screening for CAD in low-risk asymptomatic patients
None
| MKSAP 20
75
Timing of palliative medicine initiation for incurable/advanced disease
At time of diagnosis
| MKSAP 20
76
Threshold functional capacity for proceeding to surgery without further testing
4 METs
| MKSAP 20
## Footnote
METs refers to Metabolic Equivalent of Task, a measure of exercise capacity.
77
Structured communication strategies to improve handoffs
I-PASS, call-outs, SBAR, check-backs
| MKSAP 20
## Footnote
These strategies are designed to enhance communication and reduce errors during patient handoffs.
78
Test's ability to identify those without the disease
Specificity
| MKSAP 20
## Footnote
Specificity is a key concept in diagnostic testing, indicating the proportion of true negatives.
79
Ethical distinction between withholding and withdrawing care
None
| MKSAP 20
## Footnote
This indicates that there is no ethical difference between the two actions in medical practice.
80
Age to begin osteoporosis screening in average-risk women
65 years
| MKSAP 20
## Footnote
This recommendation is based on guidelines for osteoporosis prevention.
81
Recommended frequency of Td booster in adults
Every 10 years
| MKSAP 20
## Footnote
Td refers to Tetanus and Diphtheria vaccination.
82
Population appropriate for depression screening
All adults, including pregnant and postpartum patients
| MKSAP 20
## Footnote
This highlights the importance of mental health screening across various demographics.
83
Minimum preoperative DAPT duration after drug-eluting stent placement
3-6 months
| MKSAP 20
## Footnote
DAPT refers to Dual Antiplatelet Therapy, crucial for preventing thrombotic events.
84
Indications for perioperative bridging anticoagulation in patients with AF
CHA2DS2-VASc ≥7, recent thromboembolic event, mechanical heart valve
| MKSAP 20
## Footnote
These criteria help assess the risk of thromboembolism in atrial fibrillation patients.
85
Pneumococcal vaccination for immunocompetent patients aged ≥50 years
PCV20 alone, PCV21 alone, or PCV15 followed by PPSV23 ≥1 year later
| MKSAP 20
## Footnote
PCV refers to Pneumococcal Conjugate Vaccine, and PPSV23 refers to Pneumococcal Polysaccharide Vaccine.
86
Hospital VTE prophylaxis following hip fracture or total knee/hip arthroplasty
Concomitant mechanical and pharmacologic prophylaxis
| MKSAP 20
## Footnote
This approach reduces the risk of venous thromboembolism in surgical patients.
87
Effect of behavioral counseling interventions on cardiovascular events
20% reduction
| MKSAP 20
## Footnote
This statistic reflects the efficacy of counseling in promoting heart health.
88
Calculation for number needed to treat
1/absolute risk reduction
| MKSAP 20
## Footnote
This formula helps determine the effectiveness of a treatment.
89
Targeted screening in high-risk patients
Case finding
| MKSAP 20
## Footnote
This strategy focuses on identifying patients who may benefit from screening based on risk factors.
90
Preoperative laboratory testing in patients with CKD
Serum electrolyte and creatinine levels
| MKSAP 20
## Footnote
CKD refers to Chronic Kidney Disease, making these tests vital for surgical safety.
