PCM REVIEW

Question 1

what percentage of US adults smoke?

Answer 1

21%

Question 2

how many people start smoking by age 18?

Answer 2

80%

Question 3

how many deaths annually can be attributed to smoking?

Answer 3

1 in 5

Question 4

what is the leading preventable cause of death in the US?

Answer 4

smoking

Question 5

if you tell someone to quit at each visit you can raise the quit rate by______________

Answer 5

30%

Question 6

what are the 5 A’s?

Answer 6

1. ask about tobacco use
2. advise to quit
3. assess willingness to try
4. assist in quit attempt
5. arrange followup

Question 7

what are the 5 stages of change?

Answer 7

precontemplative
contemplative
preparation
action
maintenance

Question 8

what percent of people who try to quit on their own are smoking within 30 days?

Answer 8

80%

Question 9

what percentage of smokers quit successfully annually?

Answer 9

3%

Question 10

how is cognitive therapy involved in smoking cesation?

Answer 10

helps smokers combat addiction, craving triggers, stress/environmental cues and withdrawal sings

Question 11

what happens to quit rates when counseling is combined with pharmacotherapy?

Answer 11

quit rates double

Question 12

how does varenicline work?

Answer 12

partial agonist at the alpha4beta2 nicotinich ACh receptor

Question 13

which antismoking drug is the most effective alone?

Answer 13

varenicline

Question 14

what are notable adverse effects of varenicline and buproprion?

Answer 14

psychiatric adverse effects

Question 15

how does buproprion work?

Answer 15

NE and dopamine re-uptake inhibitor (decreases cravings and withdrawal symptoms while interactin with pathways underlying addiction)

Question 16

rank the smoking cessation drugs from best to worst>

Answer 16

Varenicline>buproprion>nicotine replacement

Question 17

what is a notable side effect of clonidine?

Answer 17

rebound htn

Question 18

how does mecamylamine work?

Answer 18

nicotine antagonist (ganglionic blocker) data shows that mecamylamine + nicotine is better than nicotine alone

Question 19

how does clonidine work?

Answer 19

blocks cravings, anxiety, restlessness, tension and hunger

Question 20

how does naltrexone work?

Answer 20

opiate antagonist (DOESNT WORK)

Question 21

what pts shouldnt get mecamylamine?

Answer 21

coronary or renal insufficiency, glaucoma, uremia

Question 22

who is supposed to get the flu shot?

Answer 22

pts 6 months and older

Question 23

what are the 2 kinds of flu shot?

Answer 23

1. shot is inactivated killed virus

2. nasal spray is live attenuated virus (only for healthy people 5-49 yrs)

Question 24

how many strains does each vaccine have?

Answer 24

3

Question 25

adults get which pneumococcal vaccine?

Answer 25

23 valent inactivated vaccine

Question 26

kids get which pneumococcal vaccine?

Answer 26

7 valent conjugate vaccine

Question 27

bronchial breath sounds + egophony triples the likelihood of what?

Answer 27

pneumonia in pt with fever and cough

Question 28

the algorithms for cough are indicated for what patients?

Answer 28

15 yrs and older

Question 29

upper airway cough syndrome (UACS) is also known as what?

Answer 29

post-nasal drip

Question 30

pts with pneumonia and risk factors for lung cancer should have a follow up CXR around when?

Answer 30

6-12 wks - assure resolution - avoid missing a lung cancer hidden by infiltrates

Question 31

what kind of things cause a subacute cough?

Answer 31

usually subacute | -pertussis

Question 32

post-tussive vomiting and paroxysmla cough in a subacute setting are sugestive of what?

Answer 32

pertussis

Question 33

how do you treat pertussis?

Answer 33

erythromycin

Question 34

if you have a chronic cough and you've done a good hx and physical what else do you need to order?

Answer 34

CXR

Question 35

if you have a pt where the history, physical, and CXR are normal, what are 4 possible causes?

Answer 35

smoking ACE-inhibitor GERD Asthma

Question 36

do you have to evaluate a change in chronic cough if the pt is a smoker?

Answer 36

YES

Question 37

True or False: all that wheezes is asthma

Answer 37

FALSE

Question 38

how do you diagnose asthma?

Answer 38

clinical based on multiple findings in hx (no specific test )

Question 39

asthma is easily recognized when it presents with what?

Answer 39

intermittent wheezing

Question 40

what should be high on your ddx if your pt has: wheezing, dyspnea, cough, chest tightness

Answer 40

asthma

Question 41

what are some findings in asthma with high likelihood ratios?

Answer 41

nocturnal dyspnea | wheezing and exertional dyspnea

Question 42

what are the key points to diagnosing asthma?

Answer 42

episodic symptoms of airflow obstruction reversibility of airflow obstruction exclusion of other likely diseases

Question 43

how do you know if you should hospitalize an asthmatic patient?

Answer 43

pts w/ an exacerbation and 1 of the following: - hx of sudden severe exacerbations - prior admission to ICU - recent ER visit - use of 2 or more canisters of beta2agonist in last month

Question 44

what can the physical exam tell you about a pt with asthma?

Answer 44

not much, generally a poor marker of the severity of disease

Question 45

what 2 pieces of info are the most important for making admission decisions?

Answer 45

1. spirometry | 2. hx of the pt's prior exacerbations

Question 46

a succinct and complete __________________ should always be included in oral presentations and written histories and physicals in the respective assessment sections

Answer 46

illness script

Question 47

what is the purpose of an illness script?

Answer 47

1. facilitate diagnostic thinking 2. better communicate your conclusions to others 3. give others insight into your diagnostic reasoning

Question 48

define a likelihood ratio

Answer 48

(probability of a finding in pt w/ disease) / (probability of same finding in pt w/o disease)