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Flashcards in General Internal Deck (69)
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1

sensitivity

percentage of pts with disease who have a positive screening test
- a / a+c

2

specificity

- percentage of normal pts with a negative screening test
- d / d+b

3

What happens to PPV and NPV as the prevalence of a disease decreases?

as prevalence decreases, PPV decreases and NPV increases
- opposite is true if disease prevalence increases

4

positive predictive value

TP/ TP + FP
- probability that a person actually has disease given a positive test result

5

positive likelihood ratios of 2,5 and 10 increase the probability of disease by....

15%, 30% and 45% respectively

6

screening for abdominal aortic aneurysm

men aged 65-75 who smoked, should undergo one time screening with USG

7

screening for osteoporosis

women 65 yo or older or women over 60 yo w/ significant fracture risk factors
men only with certain RFs - long term steroid use, androgen deprivation

8

pneumococcal vaccine

all pts > 65 yo
- if over 65, should get second dose in 5 years
- second dose after 5 yrs also for pts with CKD, asplenia, cancer or IC pts

9

influenza vaccine in COPD pts

annually - trivalent killed vaccine
- its actually recommended for everyone over 6 months of age

10

who is the intranasal trivalent live attenuate influenza virus vaccine indicated for?

pts ages 5 to 49 who are NOT pregnant, IC or living with an immunosuppressed pt

11

what is the best end-point for measuring the effect of cancer screening on patient outcomes?

cancer-specific mortality

12

length bias

preferential detection of asymptomatic, more indolent cancers by any screening test
- this influences the case fatality ratio

13

lead time bias

patient survival after cancer diagnosis is artificially prolonged by screening

14

indications for herpes zoster vaccine

immunocompetent patients age 60 or older
- live attenuated zoster vaccine, single subcutaneous dose
- reduces incidence of herpes zoster and postherpetic neuralgia

15

contraindications to herpes zoster vaccine

live vaccine, therefore:
- people with active, untreated TB
- pregnant women
- immunocompromised pts
- pts receiving chemo, radio or immunosuppressants
- living in same house as IC pt

16

in whom is tetanus immune globulin indicated?

pts who have not completed the primary series of tetanus immunizations or in pts who have an unclear immunization history

17

recommendations for HPV vaccine

all females between ages 9 and 26, regardless of sexual activity

18

acceptable CRC screening methods

screening should begin at age 50
1. annual FOBT
2. colonscopy every 10 years
3. flexible sigmoidoscopy every 5 years + FOBT every 3 years

19

pt with syncope with prodromal symptoms of nausea, lightheadedness and diaphoresis lasting > 10 secs

vasovagal (neurocardiogenic) syncope
- may also have brief myoclonic jerks after LOC

20

in pt with suspected vasovagal syncope, but otherwise healthy - what do you do next?

no further testing required

21

syncope with sudden LOC and lack of preceding symptoms resulting in pt falling and injuring themself

cardiogenic syncope - ex. heart block

22

tx. of trifascicular heart block

if asymptomatic - nothing
if symptomatic - pacemaker

23

indications for permanent pacemaker implantation

intermittent 3rd degree block
type 2- 2nd degree block
alternating BBB

24

implantable loop recorder

continously records the ECG and allowes pt to save the previous 30 sec and 2 mins (Adjustable) after they have an episode

25

causes of obstructed cardiac output that lead to syncope

severe aortic stenosis
hypertrophic obstructive cardiomyopathy
cardiac ischemia

26

best test to evaluate recurrent syncope

implantable loop recorder
- records pt activated events and automatically records bradycardic and tachycardic events

26

what do you do with depressed pt who does not respond to full-dose therapy within 6 weeks?

should receive another medication (can be within same class) OR referral to psychotherapy

27

when can you add methylphenidate to depression tx?

no benefit of methylphenidate augmentation in treatment-resistant depression

28

indications for ECT therapy in depression?

profound suicidal ideations
psychotic features present
pt fails to respond to multiple antidepressants

29

best predictor of completed suicide

previous suicide attempts