Health Screening

Question 1

when should colonoscopy screening begin for people w/ no family hx

Answer 1

age 50

Question 2

when is colonoscopy screening stopped?

Answer 2

when age expectancy is less than 10 yaers

Question 3

three screening option for adults >50 for colorectal cancer

Answer 3

annual fecal occult blood testing (FOBT)
flexible sigmoidscopy every 5 years w/ FOBT every 3 years
colonoscopy every 10 years

Question 4

who should receive a PAP smear

Answer 4

women aged 21-65 who have a cervix

Question 5

when should pap smears be done for average-risk women age 21-29

Answer 5

at three year intervals

Question 6

when should pap smears be done for women age 30-65

Answer 6

Pap every 3 years of pap plus HPV every 5 years if both inital tests are negative

Question 7

who should get bone mineral density testing?

Answer 7

women 65 and older , men with hx of fractures and other potential risks of osteoporosis

Question 8

what screening test is used for osteoporosis

Answer 8

DXA of the hip and spine

Question 9

most common clinical manifestation of osteoporosis

Answer 9

vertebral fracture (2/3 are asymptomatic)

Question 10

what is an osteopenic T score?

Answer 10

1-2.5 standard deviations below the young adult mean

Question 11

what is an osteoporotic T score?

Answer 11

2.5 standard deviations or more below the young adult mean BMD

Question 12

what is a Z score?

Answer 12

comparision of the patient’ BMD to an age-matched populations

Question 13

what Z score is below the expected range for age?

Answer 13

-2.0 or lower (look for xo-exisiting problems that can contribute to osteoporosis

Question 14

how much calcium should postmenopausual take *supplemental)

Answer 14

500-1000 mg/day in divided doses

Question 15

how much Vitamin D should postmenopausal women take?

Answer 15

800 international units dialy

Question 16

First line therapy for postmenopausual women w/ osteoporosisi

Answer 16

alendronate or risedronate or IV if they can’t tolerate these

Question 17

what is the only IV bisphosponate that has demonstrated efficacy for fracture prevention and is the agent of choice?

Answer 17

zoledronic acid

Question 18

what is a monoclonal antibody used to treat osteoporosis. It is administered subQ

Answer 18

denosumab

Question 19

clinical manifestation of chronic adrenal insufficiency

Answer 19

weakness, fatigue, anorexia, N/V/C/D, salt craving, posturnal diziness, Hypotension, hyperpigementations

Question 20

electrolyte distrubances seen with chronic adrenal insufficiency

Answer 20

hyponatremia

hyperkalemia

Question 21

Tx for acute adrenal crisis

Answer 21

hydrocortisone

Question 22

how does someone with hyperaldosteronism present?

Answer 22

hypertension and hypokalemia

Question 23

Tx of primary aldosteronism

Answer 23

normalize BP and serum potassium with spironolactone and potassium supplements
definitive tx is surgery to remove the adenoma (most common cause)

Question 24

risk factors for hyperlipidemia

Answer 24

smoking, HTN, DM< advanced age, family history

Question 25

what does dylipidemia mean

Answer 25

elevated LDL and low HDL

Question 26

what is an acute phase reactant tha tincreases during inflammation and is a moderate predictor for CHD risk independent of other major CHD risk factors

Answer 26

C-reactive protein (CRP_

Question 27

how much does cholesterol increase on average per year

Answer 27

2 mg/dL in early adult hood

Question 28

does caloric excess raise cholesterol or triglycerides more

Answer 28

triglycerides

Question 29

what med for HTN can increase LDL temporarily

Answer 29

thiazide diuretics

Question 30

what med can reduce HDL cholesterol and increase serum triglycerides (cardiac med)

Answer 30

beta blockers

Question 31

what are some causes of secondary hypercholesterolemia

Answer 31

hypothyroidism, nephrotic syndrome, obstructive liver disease

Question 32

when should patients get a fasting lipid profile

Answer 32

everyone older than age 20

Question 33

what is a desirable ratio of total cholesterol to HDL cholesterol

Answer 33

4.5

Question 34

if LDL is high and HDL Is low what drug (that is also a vitamin) can be used?

Answer 34

Niacin

Question 35

individuals with the highest risk (CHD< DM) should have an LDL goal of what?

Answer 35

<70

Question 36

What can increased HDL?

Answer 36

aerobic exercise, smoking cessation, weight loss

Question 37

what drugs are good for elevated triglycerides

Answer 37

gemifibrozil, fenofibrate

Question 38

a fibrate plus a statin can lead to what

Answer 38

increase risk of rhabdomyolysis

Question 39

who should get TSH screening

Answer 39

Women >50, who have had external neck irradiation, thyroid surgery, newly pregnant women

Question 40

if the patient appears clinically and biochemically hypothyroid but the TSH isn't elevated what shoudl be done

Answer 40

test for pituitary insufficiency

Question 41

how long does it take for a new dose of levothyroxine to take effect?

Answer 41

4-6 weeks

Question 42

first line tests for cushings

Answer 42

late night salivary cortisol, urinary cortisol and low-dose dexamethasone supression tests

Question 43

most common cause of cushing's

Answer 43

iatrogenic due to pharm doses of glucocorticoids

Question 44

clinical manifestations of cushing's

Answer 44

``` supraclavicular fat pads centripetal obesity hirsutism skin atrophy wide purplish striae proximal muscle weakness ```

Question 45

drugs to tx cushing's due to a ACTH tumor that wasn't cured by pituitary surgery

Answer 45

cabergoline or pasireotide