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Flashcards in General Questions Deck (50):
1

Magic words: Filipino (2)

1. Gout
2. Disseminated coccidioidomycosis

2

Maigc words: Caucasian (3)

1. Polymyalgia rheumatica
2. Temporal arteritis
3. Pernicious anemia

3

Magic words: Southeast Asian (2)

Rheumatic heart disease, tuberculosis

4

Magic words: Japanese (2)

Gastric carcinoma, moya moya

5

Dermatitis Herpetiformis
1. Onset
2. Features (3)
3. Diagnosis
4. Therapy

1. Onset: 2nd-3rd decade
2. Features:
pruritic vesicles on extensor surfaces
gluten sensitive enteropathy
iodide sensitivity
3. Dx: Biopsy with IgA deposits at dermal-epidermal junction
4. Tx: Dapsone and gluten-free diet

6

Four lab changes with Tumor Lysis Syndrome

1. Increased potassium
2. Increased phosphate
3. Increased nucleic acid (-->uric acid)
4. DECREASED calcium

7

Management of complete heart block in:
1. Asymptomatic patient (3)
2. Symptomatic patient (3)

1. Asymptomatic: stop medications and observe, have pacer available
2. Symptomatic: Atropine and pacing, consider glucagon

8

Boerhaave Syndrome
1. What is it?
2. What is seen on CXR?
3. What is preferred diagnostic study?
4. What is contraindicated?

1. Spontaneous esophageal rupture
2. CXR with mediastinal air with subsequent pleural effusion
3. Gastrograffin swallow - water-soluble constrast esophagram to localize site of perforation
4. NO EGD

9

Diffuse Esophageal Spasm - Radiologic findings and treatment?

1. Barium swallow with corkscrew esophagus
2. Calcium channel blocker

10

Which medication (classes and specific) is contraindicated with Simvastatin (6)?

1. Calcium channel blockers (dilt>>amlo)
2. Imidazole (itra- and ketoconazole)
3. Macrolides (clarithromycin not azithro)
4. Protease Inhibitors
5. Cyclosporin
6. Nefazadone (antidepressant)

11

What is the difference between Familial Hypercholesterolemia and Familial COMBINED Hypercholesterolemia?

FH = Elevated (very) LDL; Normal TAG
***Tendinous xanthoma

FCH = Elevated LDL; Elevated TAG

12

What is the work-up for dementia (8)?

1. CBC
2. CMR
3. TSH
4. RPR/VDRL
5. B12/folate
6. CXR
7. EKG
8. CT or MRI - for NPH or SDH or tumor

13

What is the formula for Sensitivity, Specificity, PPV and NPV?

Disease
Test + -
+ T(a) F(b)
- F(c) T(d)

Sensitivity a / (a + c)
Specificity d / (b + d)
PPV a / (a + b)
NPV d / (c + d)

14

What is the formula for NNT?

1 / absolute risk reduction OR
1 / (control rate - intervention rate)

15

Who should be screened for AAA?

Men 65-75yo who have ever smoked

16

1. Who should be screened for osteoporosis?
2. What weight is predictive of low bone mineral density?

1. Women >65yo or Women>60yo with risk
2. 70 kg

17

Who should NOT get HPV testing?

Women younger than 30yo

18

What is the recommended mammography frequency? What is the upper age limit?

For women >50-74yo, every two years

19

What is the recommended age for the Zoster vaccine?

>60yo

20

What is the recommended age for the Pneumococcal vaccine?

>65yo

21

Who should receive HAV vaccine (6)?

1. Children >2yo in high-risk states
2. Travel to endemic areas
3. Chronic liver disease
4. IVDU
5. High-risk sexual activity
6. Lab personal working with HAV

22

1. Which age ranges for men and women benefit from daily baby Aspirin?
2. At what age may the risks outweigh the benefits?
3. Name two groups that should not receive baby Aspirins?

1. Men 45-79 (for CHD) and Women 55-79 (for stroke)
2. Both genders older than 80yo
3. a. Taking chronic NSAIDs
b. GI upset

23

Who should be screened for GC and CT (2)?

1. Women under 24yo
2. Pregnant women

24

Who should be screened for HCV?

Those born between 1945 and 1965

25

1. Who should be screened for hyperlipidemia (2)?
2. What test should be performed?

1. a. Men > 35
b. Women > 45

2. Total cholesterol and HDL, then full panel if abnormal

26

1. When should cervical cancer screening begin?
2. What is the cervical screening frequency?
3. When should screening be stopped?

1. Age 21 or within 3y of onset of sexual activity
2. Annually for 2-3 years then every 1-3 years
3. Age 65 if repeatedly normal paps

27

Who should receive a Td (tetanus vaccine) and TIG (tetanus immune globulin)?

1. Dirty wounds:
2. Unknown or less 3 doses

28

1. In which patients should post-vaccine anti-HBV titers be checked (2)?
2. What is defined as a non-responder and what should they receive?

1. Age > 30 or healthcare workers
2. HBsAb <10 should receive 3 additional doses

29

Who should receive endocarditis prophylaxis (3)?

1. Prosethetic cardiac valves
2. Previous infective endocarditis
3. Congenital heart disease

30

What procedures should NOT have endocarditis prophylaxis (3)?

1. Bronchoscopy
2. Genitourinary procedures
3. Gastrointestinal procedures

31

1. What is the goal for LDL (3)?
2. In general, what age should one start treating hyperlipidemia?
3. What risk score threshold is used for treatment of HLD?

1. a. Decrease > 30%
b. LDL < 100
c. LDL < 70 for DM, CABG, ACS
2. Age > 40 years
3. Risk >= 20%

32

How does the treatment benefit for DM and HLD differ?

DM control = microvascular disease
HLD control = macrovascular disease

33

1. What is the goal for LDL (3)?
2. In general, what age should one start treating hyperlipidemia?
3. What risk score threshold is used for treatment of HLD?

1. a. Decrease > 30%
b. LDL < 100
c. LDL < 70 for DM, CABG, ACS
2. Age < 40 years
3. Risk >= 20%

34

How does the treatment benefit for DM and HLD differ?

DM control = microvascular disease
HLD control = macrovascular disease

35

What is the formula for:
1. Positive Likelihood Ratio
2. Negative Likelihood Ratio

1. Sensitivity / 1-Specificity
2. 1-Sensitivity / Specificity

36

How much do these LR increase or decrease the probability of disease?
LR 10
LR 5
LR 2
LR 1
LR 0.5
LR 0.2
LR 0.1

LR 10 = +45%
LR 5 = +30%
LR 2 = +15%

LR 1 = 0

LR 0.5 (1/2)= -15%
LR 0.2 (1/5)= -30%
LR 0.1 (1/10) = -45%

37

What risk score is used for cohort studies, randomized-controlled trials and case-control studies?

Cohort = Relative Risk
RCT = Relative Risk
Case-Control = Odds Ratio

38

Describe linear timeline for each:
1. Case-control
2. Cohort

1. Retrospective
2. Prospective

39

Describe the difference between Type I and Type II errors. Which is prone to Type II.

1. Type I - Incorrectly concluding there is a statistically significant difference between experimental and control groups.

2. Type II - Incorrectly concluding there is a NO statistically significant difference between experimental and control groups. Occurs in SMALL and LOW POWERED tests.

40

List live vaccines that are contraindicated in pregnancy (5)

1. MMR
2. Intranasal influenze
3. Yellow fever
4. Varicella
5. Zoster

41

What are indications for bariatric interventions for obesity (2)?

1. BMI greater than 40
2. BMI 35-40 with comorbidities (DM, OSA, joint disease)

42

How do the Framingham and Reynolds Risk assessment tools differ?

Framingham:
1. Age
2. Gender
3. BP
4. Cholesterol with HDL
5. Tobacco

Reynolds (better for women under 70)
1. Family history
2. hsCRP

43

1. What is considered a high hsCRP?
2. In combination with what lab value would warrant starting Rosuvastatin?

1. >0.2 mg/dL
2. LDL < 130

44

For patients who are intolerant of statins who require lipid lower drugs, what should you prescribe (4)? Describe effect on LDL, HDL and TAG.

1. Fibrates: Fenofibrate/Gemfibrozil
LDL - unreliable
HDL - raise 15%
TAG - lowers 50%

2. Bile Acid Binders: Colesevelam
LDL - lowers in women
HDL - none
TAG - Contraindicated if >200

3. Nicotinic Acid: Niacin
LDL - lowers 25%
HDL - raises 15% (gout, flushing, DM)
TAG - lowers 25%

4. Ezetimibe
LDL - lowers with statin (liver dz, fibrates)
HDL - nothing
TAG - lowers 8%

45

1. What are symptoms of Central Retinal Vein Occlusion (1)?
2. What is seen on fundoscopy (2)?

1. Painless blurry vision (bc still blood supply)
2. "Blood and thunder": retinal hemorrhages & cotton-wool spots

46

1. What are symptoms of Acute Angle Closure Glaucoma (2)?
2. What is seen on fundoscopy (2)?

1. a. Significant pain
b. "Halos around lights"

2. a. Firm globe
b. Dilated pupil

47

1. What are symptoms of Central Retinal Artery Occlusion?
2. What is seen on fundoscopy (2)?

1. Painless blurry or loss of vision in AM
2. Pale retina with "cherry red spot" and "boxcar-ing"

48

What are the diagnostic criteria for Metabolic Syndrome (5)?

Three or more:
1. Waist greater 40-in men or 35-in women
2. BP greater 130/85
3. HDL less 40 men and 50 women
4. TAG greater 150
5. Glucose greater 110

49

What is Chlorpheniramine, and what is its indication?

Antihistamine for rhinitis

50

What is a symptom of Macular Degeneration?

Loss of central vision