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ICM Exam > ICM Exam > Flashcards

ICM Exam Flashcards

1
Q

background v. foreground questions

A

Difference is specificity of the question. Background ask what’s true of the world in general, whereas foreground q’s ask about specific aspects of a given patient. The answers to foreground can DIRECTLY improve outcomes for that patient.

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2
Q

Background or foreground question?

‘Does Atrovent improve bronchospasm in asthmatics?’

A

background

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3
Q

Give ex of foreground question

A

Does Atrovent given by nebulization prevent hospital admission in wheezing children aged 6-10 yrs who present to the ED?

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4
Q

What is the PICO format? What does it stand for?

A 
Purpose is to take your clinical question and break it down into subcomponents to make it searchable.
P = Population or Patient
I = Intervention
C = Comparison or Control
O = Outcome Measured
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5
Q

What does the I in PICO stand for?

A

Intervention (as in therapy, diagnostic test or exposure)

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6
Q

What does the C in PICO stand for?

A

Comparison

May want to compare the chosen intervention to another intervention or to no intervention

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7
Q

What is the “ideal” format to answer a PICO question?

A

a systematic review, which is Level I Evidence

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8
Q

What study design best answers a question about Intervention or Therapy?

A

randomized controlled trial

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9
Q

What study design best answers a question about the ACCURACY of a test?

A

Cohort study where all subjects receive BOTH the study test and gold standard reference test

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10
Q

What study design best answers a question about the EFFECT of a test on health outcomes?

A

randomized controlled trial

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11
Q

What study design best answers a question about prognosis?

A

longitudinal cohort

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12
Q

What are the (5) clinical question types?

A
  • General learning questions
  • Fact questions
  • EBM questions
  • Societal questions
  • Explorative questions
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13
Q

general learning questions, definition and (3) examples

A

pretty broad medical questions; most common for students and younger residents. Asks q’s such as:

What is the diff dx? What is the pathophysiology? What are the tx options?

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14
Q

Fact questions, definition and (3) examples

A

focused questions that need to be answered in “real time” to support pt care. Include:

What is the drug of choice? What are most common risk factors? Which diagnostic test is preferred?

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15
Q

What resource is best for answering fact questions?

A

online EBM resources

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16
Q

EBM questions, definition and (3) examples

A

“big” questions, intended to guide clinical practice for frequently-encountered pt situations. Include:

What is the guideline-based or best treatment? What is the best diagnostic or screening strategy? What is the prognosis?

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17
Q

Societal questions, definition and (3) examples

A

questions about population health, risk factors, epidemiology, etc. These don’t generally impact pt care directly, but are important to understand. Include:

What are the population risk factors? Has the survival of this disease changed? What treatments are being investigated? How do I resolve this ethical issue?

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18
Q

Explorative questions, definition and (3) examples

A

broader questions that relate to general issues in medicine, role of physician, interaction with pts, etc. are NOT disease-specific learning

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19
Q

Ex of a leading question

A

You’re not having any chest pain, are you?

20
Q

How do you elicit the full spectrum of patients concerns within first few minutes?

A

Ask: “What else is on your list today?” BEFORE delving into chief complaint

21
Q

Define Addiction, including (2) things it is different from

A

A BEHAVIOR disorder where people continue to use despite its negative consequences. It is DIFFERENT from physiologic dependence or ‘drug-seeking’

22
Q

Define pseudo-addiction

A

people on narcotic pain meds and taking more than prescribed. They show some addictive behaviors, but not because they are actually addicted. Rather it’s because they are in uncontrolled pain

23
Q

Define Substance Use Disorder (SUD). What are the (4) categories of the 11 SUD criteria?

A

defined by meeting TWO of the 11 criteria within a 12 month period. (4) categories:

  • Impaired control (1-4)
  • Social impairment (5-7)
  • Risky use (8-9)
  • Pharmacological (10-11)
24
Q

What is the Impaired control category of SUD criteria?

A

Impaired control = just keep taking it and can’t cut down

e.g. Taking in large amounts, unsuccessful efforts to cut down, great deal of time spent trying to obtain substances

25
Q

What is the Social Impairment category of SUD criteria?

A

some kind of significant life issue that has happened, but they keep using in spite of that.
e.g. Failure to fulfill major obligation at work, school or home or giving up important social, occupation, or recreational activities b/c of the substance use

26
Q

What is the Risky Use category of the SUD criteria?

A

they keep using even though they know it’s putting them at risk.
e.g. Driving while impaired by substance or keep using even though they know it’s caused them problems

27
Q

What are the (2) Pharmacological criteria of SUD?

A

10) Tolerance: either need more for desired effect or markedly diminished effect with same amount
11) Withdrawal: either by having sx or by taking same/similar substance to relieve/avoid sx

28
Q

Name (2) uses NOT included in DSM-5 (diagnostic and statistical manual of mental disorders)

A

caffeine use and internet use

29
Q

How is “1 standard drink” measured?

A

13.6 grams of alcohol, which is:

5 oz of wine, 1.5 oz of liquor, or 12 oz of beer

30
Q

How is “healthy drinking” defined for men under 65 yo? For all women and men older than 65?

A

Healthy men under 65 yo:
< or = 4 drinks/day AND < or = 14 drinks in a week

Healthy women + health men older than 65 yo:
< or = 3 drinks/day AND < or = 7 drinks in a week

31
Q

What is the USPSTF recommendation for screening adolescents, adults, and pregnant women for illicit drug use?

A

I (Insufficient)

32
Q

Are open- or closed-ended questions better for getting substance use hx?

A

Close-ended questions. Open-ended tend to increase anxiety and discomfort.

33
Q

Is it better to say “illicit drugs” or “street/recreational drugs” in getting pt hx?

A

Street/recreational drugs - because you’re avoiding potentially pejorative words

34
Q

Define personality disorders

A

Enduring, ingrained, pervasive, inflexible styles of personal interaction

35
Q

One study found how many out of 21 difficult patients to have personality disorders v. the control group?

A

7 or 21 “difficult patients” had personality disorders v.

1 of 22 control patients

36
Q

cluster A personality disorders

A

Odd or eccentric:

Paranoid or schizoid

37
Q

Cluster B personality disorders

A

Dramatic or emotional:

Antisocial, borderline (“emotionally unstable”), narcissistic

38
Q

Cluster C personality disorders

A

Anxious or fearful:

Avoidant, dependent, obsessive-compulsive, dependent

39
Q

Somatization

A

Having many different physical sx over years, causing functional impairment in your life. Could have somatization as a sx or could have Somatization Disorder

40
Q

Name one important component of communicating with difficult patients

A

Emphasize most important tx goals (goal-setting in general is vitally important)

41
Q

One approach to “frequent flyer” patients

A

“Counter-intuitive” approach = see them more often. Set small, achievable goals and establish regular visit, then extend gradually

42
Q

Important action to take if you fire a patient

A

Document, document, document (court upholds firing patients for appropriate cause)

43
Q

Name (3) reasons its NOT ok to fire patients for

A
  • don’t like the pt
  • they’re difficult to tx
  • difficult to communicate effectively
44
Q

T/F: It’s ok to fire a patient due to persistent failure to keep appointments

A

True. Must demonstrate efforts to accommodate them first (“3 strikes and you’re out”)

45
Q

T/F: It’s ok to fire a pt over gross refusal to follow tx plan despite attempts at negotiation

A

True

46
Q

What is the 3rd most common cause of death in the US?

A

Medical error :/

47
Q

(3) ethical reasons for disclosing medical mistakes

A
  1. beneficence, non-maleficence (act primarily in patient’s interests)
  2. Patient autonomy (full disclosure is most consistent w/ pt autonomy)
  3. Justice (pts are due appropriate tx and compensation for harm from mistakes)

ICM Exam (1 decks)

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