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

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

General Internal Flashcards by Magda Kazmierczak

sensitivity

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

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specificity

percentage of normal pts with a negative screening test

- d / d+b

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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

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positive predictive value

TP/ TP + FP

- probability that a person actually has disease given a positive test result

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

15%, 30% and 45% respectively

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screening for abdominal aortic aneurysm

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

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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

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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

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influenza vaccine in COPD pts

annually - trivalent killed vaccine

- its actually recommended for everyone over 6 months of age

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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

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

cancer-specific mortality

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length bias

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

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lead time bias

patient survival after cancer diagnosis is artificially prolonged by screening

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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

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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

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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

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recommendations for HPV vaccine

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

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acceptable CRC screening methods

screening should begin at age 50

annual FOBT
colonscopy every 10 years
flexible sigmoidoscopy every 5 years + FOBT every 3 years

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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

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

no further testing required

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

cardiogenic syncope - ex. heart block

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tx. of trifascicular heart block

if asymptomatic - nothing

if symptomatic - pacemaker

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indications for permanent pacemaker implantation

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

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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

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causes of obstructed cardiac output that lead to syncope

severe aortic stenosis hypertrophic obstructive cardiomyopathy cardiac ischemia

best test to evaluate recurrent syncope

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

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

when can you add methylphenidate to depression tx?

no benefit of methylphenidate augmentation in treatment-resistant depression

indications for ECT therapy in depression?

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

best predictor of completed suicide

previous suicide attempts

when does a greiving person become a candidate for anti-depressant therapy?

symptoms of major depression for at least 2 weeks, 8 or more weeks after their loved one's death - essentially, when sx. persist for more than 2 months

which anti-depressant also causes sedation and weight gain?

mirtazipine

what drug is used to prevent alcohol-withdrawl induced seizures?

lorazepam | - prophylactic, on fixed schedule, even if asymptomatic

pts scoring > 10 points on clinical institute withdrawl assessement scale for alcohol withdrawl

need additional medication for withdrawl symptoms - usually benzos

pts scoring > 15 on clinical institute withdrawl assessement scale for alcohol withdrawl

require hospitalization

initial tx. of cocaine intoxication

sedation with lorazepam, IV or IM

drug of choice for drug induced seizures

benzodiazepines

which drugs are not recommended during acute cocaine intoxication?

B-blockers - worsen vasoconstriction due to unopposed alpha blocking effects

what drug is useful in alcohol dependence and in decreasing frequency of relapses?

naltrexone

management of hypoventilation caused by opioid overdose

naloxone - if inadequate, endotracheal intubation needed

IV fomepizole is used for...

ethylene alcohol or methyl alcohol poisoning

tx of cyanide poisoning

inhalation of amyl nitrate followed by IV sodium nitrate/sodium thiosulfate

CAGE questionnaire

best choice screening test for alcohol problems C - do you feel you should cut down? A - have people annoyed you by criticizing your drinking? G - have you ever felt bad or guilty about it? E - have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

Tx. of lumbar spinal stenosis unresponsive to conservative tx

surgery - minimum of 3 months of failed nonsurgical interventions

pt with back pain gradually worsening over weeks/months, fever and elevated ESR > 100 mm/hr with tenderness over palpated portion of spine

vertebral osteomyelitis

preferred imaging modality in evaluating vertebral osteomyelitis or spinal epidural abscess

MRI of spine

Tx. of vertebral osteomyelitis/epidural abscess

IV antibiotics - guided by blood cultures

when should you order an MRI for back pain?

pt has evidence of motor impairment, has not responded to therapy or symptoms are increasing; or if fever is present

first line tx of acute, nonspecific lower back pain

acetaminophen or NSAIDs | - most pts improve w/in 1 month

triad of back pain, muscle weakness and loss of bowel/bladder control suggests?

spinal cord compression

cough variant asthma

presence of airway hyperresponsiveness; confirmed when cough resolves with asthma-therapy - do a trial of albuterol

MCC of chronic cough

asthma post-nasal drip (chronic sinusitis) GERD

what do you do in pts with chronic cough > 8 weeks who does not smoke, does not take an ACEi and has a normal CXR?

trial of first gen. antihistamine-decongestant medication

what should you consider in pts who fail to respond to tx. directed at UACS, GERD and asthma?

non-asthmatic eosinophillic bronchitis | - confirmation with bronchial biopsy OR respond to inhaled corticosteroids

all pts with hemoptysis should have?

chest XRAY | - if high risk for malignancy, do CT scan even if normal CXR

are B-agonists useful in acute bronchitis?

help decrease cough severity and duration in adults when there is also WHEEZING

which drugs can be used for smoking cessation?

nortriptyline and buproprion - similar efficacy to nicotine replacement therapy varenicline - most effective

what should varenicline not be combined with?

nicotine replacement therapy - increases risk of adverse effects

what is the black box warning on varenicline and bupropion?

both pose risk of serious neuropsychiatric changes including behavioral changes, hostility, agitation, depressed mood, suicidal thoughts and behaviors and attempted suicide

indications for bariatric surgery

1. BMI > 35 and serious medical comorbidities 2. BMI > 40 and failed attempts at weight loss 3. progressive obesity (> 5kg/yr before age 30)

pt has persistent N and V occuring within the first few months after gastric bypass surgery - what could this be and what test should you order?

stomal stenosis (stricture at anastomosis of gastric pouch and jejunum) - get upper endoscopy to further assess

most appropriate management of heavy menstrual bleeding due to a known cause, ie. large fibroid

oral medroxyprogesterone acetate | - if pt is dizzy or orthostatic from blood loss, consider IV estrogen

next step in evaluation of secondary amenorrhea in a patient who just stopped OCP

progestin withdrawl challenge - menses after challenge excludes anatomic defects and chronic anovulation w/o estrogen (in other words, indicated relatively normal estrogen production and patent outflow tract)

what are the initial lab tests that should be done in evaluating secondary amenorrhea

FSH, TSH and PRL levels

CAGE questionnaire

what do you do in pts with chronic cough > 8 weeks who does not smoke, does not take an ACEi and has a normal CXR?

trial of first gen. antihistamine-decongestant medication

all pts with hemoptysis should have?

chest XRAY | - if high risk for malignancy, do CT scan even if normal CXR

what is the most worrisome side effect of bupropion?

1 in 1000 risk of seizures

next step in pts over 35 with abnormal uterine bleeding

endometrial biopsy to R/O endometrial cancer or hyperplasia

General Internal Flashcards

(69 cards)